Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

How one mom “Walked, moved around, and changed positions” to a successful hospital VBAC! October 23, 2009

Science and Sensibility’s Healthy Birth Blog Carnival #2Walk, move around, and change positions throughout labor

 

This month’s Healthy Birth Blog Carnival is “Walk, move around, and change positions throughout labor.”  This is a repost from a story I wrote back in March however, I feel like it is a really great example of how important movement and position changes are to a successful labor and birth, especially a vaginal birth after cesarean (VBAC)!  This story has been a popular posts with my readers in the past and I hope by participating in this blog carnival it reaches and helps empower more and more expecting women out there!!  In reposting this story I have highlighted all the times where Alyssa used upright positions and movement to cope with pain, help her uterus contract more efficiently, help her baby find the best position in her birth canal, use gravity to her advantage, and be an active participant in her labor!  And there is no doubt in my mind that all of these things helped her have a safe, positive and empowering VBAC experience!

 

 

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Last week I had the honor to be a part of one of the most beautiful VBAC(Vaginal Birth After Cesarean) hospital births I have ever witnessed. I would like to share that couple’s story with you today as both a feel-good tale of personal triumph and a story of inspiration for all those moms planning a VBAC out there that might stumble upon my blog. Since this is a blog about “a nurse’s view from the inside” this story is probably much different than any other birth story you might have read from the mother or father’s point of view. But then again, maybe that isn’t so bad! Enjoy!

 

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It was ten to 11 o’clock am as I walked through the lobby doors of the hospital I work at, rushing towards the elevator so I could punch in on time. As the elevator doors started to close, a hand shoved through the crack, forcing the doors back open. “Please make room!”said the woman, a phlebotomist who works in the hospital, in a shaky voice, “Woman in labor here!!”Following behind was a very pregnant woman, huffing and puffing as she waddled into the elevator, followed by what looked like her husband and her mother. “Don’t touch any buttons!”said the phlebotomist, “We’re going right up to labor & delivery!” Since that was where I was headed too, I smiled at the husband and said, “Don’t worry, you’re here now and she won’t have the baby in your car! I work up on L&D so I’ll show you were to register.” Something told me that if this woman was truly in labor then she would be assigned to me since I was just starting my shift. But she had to “pass” triage first, so after helping the family to the registration desk, I hurried into the locker room to change into my scrubs.

 

 

 Fifteen minutes later the triage nurse came to the main desk, “I’ve got a term mom, 40 weeks 5 days, who’s five centimeters,” she said, “We’re gonna need to put her in a room…. And she’s a VBAC with a ‘birth plan’.” “I’ll take her!,” I said excitingly, knowing that I have my bestdays when I can assist a woman through labor, as opposed to getting stuck on the OR team or in the high risk ward running magnesium. (Not that those women don’t need a lot of TLC too, it’s just that I like labor the most!) Birth plans, natural unmedicated labor, and getting my patients out of bed…those are my specialties!

 

 I quickly set up the room across the hall as the resident finished the patient’s history and physical in the triage room. Then I quietly knocked on the triage room door and let myself in. The patient, Alyssa*, was standing by the bed, rocking her hips back and forth, as the continuous monitors strapped to her abdomen traced the baby’s heart rate and her contraction pattern. It looked like she was contracting every 3 minutes, and the baby’s heart rate was beautiful and reassuring. Her husband, Jared, was leaning nervously against the wall and her mom, Deb, was sitting quietly in the corner. I could really tell that Alyssa was lost in “Laborland” and I wanted to make the transition to her room as seamless as possible as to not break her rhythm and concentration too much. I quietly introduced myself and with the help of Jared and Deb, moved all of their belongings across the hall as Alyssa waddled behind.

  

 I could tell that Alyssa was coping well with the contractions while standing but a quick glance at her prenatal summary revealed that she was Group B Strep positive and would need IV antibiotics (our hospital’s policy and the midwife’s order) and hence, and IV. Now I feel that I am pretty skilled at starting IVs, but I have not yet mastered starting an IV with the patient standing and swaying! So in the two minutes between the contractions, I explained to the Alyssa what I needed to do before the admission process was complete: get 5 more minutes of continuous monitoring on the baby (to equal the “20 minute strip” my hospital’s policy requires before we can switch to intermittent auscultation), take a set of vital signs, draw three tubes of blood, start an IV, and ask a few more questions. “Give me 8 minutes sitting on the bed,” I said, “and I can have everything but the interview done. The rest of the admission can be done with you standing up.” “Okay,” she said, “I can do eight minutes.” Eight minutes later the IV was in, antibiotic running, labs drawn and sent, vital signs done, monitors were removed, and the patient was helped out of bed (Phew!! That was close!! J). And it wasn’t a moment too soon because Alyssa was having a lot of back labor and sitting in bed was just making it worse!

 

 

 

Then there was a knock at the door. Here’s how the subsequent conversation went down…

 

Me: “Who is it?”

Med Student: “It’s just the medical student,” (said as he walked right into the room)

(I hadn’t yet gotten a chance to ask Alyssa if she was okay with medical students so I just kind of looked over at her and Jared and tried to judge their reaction.)

Med Student: “Hi I’m Michael. I have to ask you a few questions.”

(Have? How about “Is it okay if I ask you a few questions? Sheesh!!)

Med Student: “Are you being induced today?” (asked as he stared down at his paper)

Alyssa: “INDUCED! DOES IT LOOK LIKE I AM BEING INDUCED!”

Med Student:“Okaaaaay. Umm, any problems with this pregnancy?”

Jared: “Do you really need to ask these questions right now? The resident already asked her that stuff.”

Med Student:“Umm yeaaaah, I do. There is a lot of repetition but we have to ask again.”

Deb: “Doesn’t her prenatal summary tell you all of that?

Med Student: “Ummmmm….”

Me: “With all do respect, Michael. But I think they are trying to tell you that they do not want any medical students. Or anymore residents for that matter. Okay? So I think we are done here.”

Med Student:“Ummm, what am I supposed to tell the resident?”

Me: “Tell her I said that the next induction that comes in is all yours.”

 

As the med student left, Jared, Deb, and Alyssa all looked at me simultaneously and said “THANK YOU!” “I don’t think he was getting the hint,” said Jared. “Yeah,” I said, “I figured he needed it spelled out.” In hind sight, I think this was one of the moments that really helped me to bond with this family because after all, I understand how difficult it must be for families to come into the hospital and have to work with a nurse that they have even never met during one of the most intimate experiences of their lives!

 

I spent the next fifteen minutes finishing up the patient’s admission assessment as quickly as I could. I told Alyssa that if she was having a contraction to just ignore me, and asked Jared to help answer any questions he knew the answers to. (Unfortunately, our hospital’s pre-registration does not include performing an admission assessment and hence, it has to be done on arrival to the hospital. Usually, if a patient comes in for false/early labor a time or two, it gets done then but Alyssa had not been to the hospital her whole pregnancy, which is great, but it meant that I did have to bother her with some silly questions during labor. Kind of a bummer, but with the help of Jared, it went pretty smoothly.) It was during the admission interview that I found out some of the details of Alyssa’s pregnancy and prior cesarean section. Alyssa had an unremarkable health history and a normal, healthy, uncomplicated pregnancy. She was a G2P1, but since her first baby was born by cesarean section, she technically was considered to be a “primip” (healthcare slang a woman who is about to deliver her first baby) regarding a vaginal delivery.

 

Jared told me that when their son was born two years ago, Alyssa was persuaded into an induction at 39 weeks for “LGA” (a.k.a. large for gestational age, which by the way is NOT recognized as an appropriate indication for induction of labor by ACOG), was first given a few doses of misoprostol to “ripen” the cervix, followed by pitocin to stimulate contractions and continuous external fetal monitoring to monitor those contractions, then given a couple doses of Stadol and eventually an epidural for the pain, followed by artificial rupture of membranes to place a fetal scalp electrode after the epidural dropped Alyssa’s blood pressure and caused a prolonged fetal heart rate (FHR) deceleration, then an intrauterine pressure catheter to assess if the pitocin induced contractions were “adequate”, and eventually a cesarean section after 1 hour of pushing in a back-lying position for “failure to descent & cephalopelvic disproportion (CPD).” Thirty minutes later baby Kevin was born at approximately 2:00am, weighing in at 7lbs, 5 oz.

 

In my opinion, Alyssa was a victim of the “cascade of interventions.” Many maternity interventions, including elective induction, pain medication, artificial rupture of membranes, epidural anesthesia, back-lying positions for labor or for birth, etc. have unintended effects. Often these effects are new problems that are “solved” with further intervention causing a domino effect that ends up creating yet more problems. This chain of events has been called the “cascade of intervention” and unfortunately often leads to vacuum extraction/ forceps delivery, episiotomies or 3rd or 4thdegree tears, and even cesarean section. Many of these women are often also then mislabeled with diagnoses like “CPD,” “failure to progress,” “failure to descent,” and at the end of it all, the obstetricians turn around and say, “Thank God we were in a hospital; look at all the technology we needed! So when will your repeat cesarean be??”

 

This time, however, things were different. After the birth of their son, Alyssa and Jared started to research more about labor and birth, VBAC, and natural birth. They interviewed and chose a doctor (Dr. Z) that was supportive of natural birth and VBACs, with the statistics to prove it! And here they were now, at my hospital, ready and rearing to go! Alyssa said that for the past few days she had been having contractions “on and off” but that they really started to get going at 8:00 am. When the resident had checked her on admission, her water spontaneously broke during the vaginal exam at 11:15am. It was now 11:45am and Dr. Z’s midwife entered the room. Although it had only been 30 minutes since her last vaginal exam, the midwife decided she would check Alyssa again since she seemed pretty active. And boy was she ever! The midwife’s exam showed that Alyssa had progressed to 7-8 centimeters! “I don’t think I can do this anymore,” Alyssa softly whimpered to the midwife. We all reassured her that she was doing so well and that things were getting more intense for a reason and to stick with it!!

 

The midwife then offered to help Alyssa into the shower to help alleviate her back pain. Alyssa seemed skeptical at first but we assured her that if it wasn’t helping, that we could get her right back out. So Alyssa agreed and the midwife and I, along with Jared, helped the patient into the shower. What happened for the next hour was one of the most beautiful displays of love, perseverance, hard work, and dedication I have ever witnessed. Alyssa turned her back to us and rested her hands on the grab bar on the shower and her head on the shower wall. Her cadence was this: Between contractions she would sway side to side, as if she was slow dancing. During contractions she would squat up and down, up and down, moaning in a low tone as she carried out her ritual. She just moved with the rhythm of her labor, listening so instinctively to what her baby and her body were telling her to do.Jared used the hand held shower head to spray Alyssa gently with a stream of warm water up and down her body, concentrating mostly on her lower back. I quietly entered the bathroom a few times that hour to check the baby’s heart rate with the portable doptone, trying hard not to disturb Alyssa’s concentration. Mostly, however, the midwife, her mother, and I stayed outside the bathroom door as to give Alyssa & Jared the privacy they needed to facilitate the progress of her labor.

 

At 12:35pm Alyssa told me that she was starting to feel a strong urge to push. The midwife entered the room and as Alyssa knelt in a hands and knees position in the tub, the midwife checked her cervix. To everyone’s surprise Alyssa only had an anterior lip of cervix left to go (this means she was about 9 ½ centimeters dilated)! After the next contraction, Jared and I helped Alyssa out of the shower to the toilet where we both used warm towels to dry her off. Then Alyssa walked over to the bed, “Can I kneel on my hands and knees?” she asked. “Sure!” we all said in unison, as we helped her up onto the bed. “I feel like I have to push!” Alyssa said convincingly and when the midwife checked her cervix, the anterior lip was gone…Alyssa was fully dilated at 12:45pm, only 1 hour and 55 minutes after arriving at the hospital! “You can start to push anytime,” said the midwife.

 

One of the best things about being a part of this experience was the fact that it was one of the only times that I have been present at a delivery where that a birth attendant has allowed the mother to use spontaneous or mother-directed pushing, as opposed to directed pushing. I knew that Alyssa was interested in using a variety of pushing positions for the second stage of labor from her birth plan and for the next hour and a half the midwife, Jared, Deb, and I helped Alyssa get into a variety of positions including right/left side lying, squatting, hands and knees, and kneeling.

 

(Side Note: I would like to digress for a moment to point out how important it is to be physically fit during your pregnancy whether you are planning for a natural birth or not. Many a woman I take care of blindly fills out a “birth plan” they find online where they can click on the boxes for options that sound “good” to them, without actually researching or thinking over what they are writing down. For example, they say that they want to try squatting during labor and birth, but couldn’t even do a squat at the gym pre-pregnancy. Although it is definitely true that a woman can sum up and realize an incredible amount of strength during labor and birth related to not only hormones but also sheer will power, it should also be known that labor is HARD WORK and pushing out a baby is HARD WORK which both require a great deal of physical strength and stamina. This is yet another reason why it is so important to follow a modified exercise plan and eat a healthy well balanced diet rich in protein and omega-3 fatty acids before, during, and even after your pregnancy.) Let’s continue with Alyssa’s story…

 

What was so amazing was that although there were plenty of times during the labor and pushing phase that Alyssa would doubt her ability to go on (“I can’t do this anymore!” “The baby isn’t moving?” “Is the baby moving?” “I am so tired!”), she never gave up on herself. Each time she made a comment like that, we all took it as a request for more support. And every time we gave her more encouragement, cheers, and reminders of her progress and goals, (“Keep going!”, “You are doing so well!”, “We can see so much more of the baby’s head!”, “She has lots of hair!”, “Just a few pushes more”, “You are so strong, you are going to do this!”, “You can do this!”), she found the ability to keep going! Towards the end of the pushing stage Alyssa was (understandably) exhausted and was pushing in a modified lithotomy position while Jared and I supported both of her legs. Then all of a sudden Alyssa popped up and said (and I quote)…

 

“I need GRAVITY! I need to be UP!” as she sat upright into a full squat and

PUSHED her baby’s head out with one gigantic ROAR!

 

“Whoa, whoa!” the midwife and I said almost simultaneously, “Easy, easy, baby pushes.” “Blow like you are blowing out birthday candles,” I said. The midwife checked for a cord around the neck (which there was none) and cleared the baby’s mouth and nose. And with only a few more “baby pushes” Addison Joy was born at 2:27pm!

 

The room erupted into cheers of excitement and tears of happiness! I put the baby skin to skin on mom as I dried her off with warm blankets and cleared her mouth and nose with the bulb suction. A quick palpation of the baby’s cord revealed that her heart rate was nice and strong and she was pinking right up! Jared and Alyssa kept hugging and kissing each other and talking to their new baby girl, “Hi Addison! Hi baby girl! I am so glad to finally meet you!”  The midwife waited until the cord stopped pulsating before she cut it (per mom and dad’s birth plan) and then checked Alyssa for any tears. Except for some swelling, she only had a small tear on her right labia that didn’t even require any stitches!! We kept mom and baby skin to skin for a full hour after birth and baby Addison nursed almost the whole time. When she was an hour old, I weighed her to satisfy mom’s curiosity and to everyone’s surprise the baby weighed 9 lbs 3 ozs!!!

 

So much for “cephalopelvic disproportion” huh!!

 

And it was as I handed baby Addison back to Alyssa that she looked up at me and said softly, “I needed to know my body could do it. I knew my body could do it! I really needed this. Thank you.” So as you can imagine, I started to well up. I have never felt so honored to be a part of something so special. What a privilege to have a job where I witness the miracle of birth and the miracle of motherhood every week!

 

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So let’s recap shall we. Alyssa, after having a cesarean section for her 7 lb 5oz son two years earlier for “CPD” and “failure to descent”, pushed out a 9lb 3oz baby after a 6 hour and 27 minute labor, including 1 hour and 42 minute of mother-directed pushing, without any pain medications or an epidural, monitored by intermittent auscultation, needing not a single stitch to her perineum! Her tools included good and relevant labor & birth preparation, appropriate and helpful family support, sheer strength, determination, and will power. The midwife’s arsenal included extensive knowledge of and experience with natural birth and labor support, a doptone, a trust in birth, and a belief in Alyssa’s ability to do it! No medications, no vacuums, no scalpels, no scissors, and no doubt!

 

Boy how I love my job sometimes 🙂

 

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*As always, names and any identifying information have been changed to protect privacy.

 

For more information on VBAC please visit: International Cesarean Awareness Network and Childbirth Connection

 

For more information on how you can move and groove through your labor check out: 

  • The Healthy Birth Practice Paper, written by Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE
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  • The Healthy Birth Your Way handout on movement in labor(PDF), produced by Lamaze International and InJoy Birth & Parenting Videos
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  • Companion tip sheets, “Maintaining Freedom of Movement” (PDF) and “Positions for Labor” (PDF)
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    Don’t Let This Happen To You #24 PART 2 of 2: Jessica & Jason’s Back Door Induction April 21, 2009

    Continuation of the “Injustice in Maternity Care” Series

     

    Please see, Don’t Let This Happen To You #24 PART 1

     

    My first hour with Jessica & Jason was spent getting to know them, tidying up the room, setting it up the way I like it (I know, sometimes I can be a bit anal about clutter!  I don’t know how some nurses can work in so much clutter!!), and turning up the pitocin a couple of times.  Around 4:00pm I had left the room to scrounge around for a few more pillows for Jessica.  This took me about 10 minutes since pillows are pretty much like gold in the hospital: rare to find and very precious to have!!  Haha!  Anyways, as I walked into the room Dr. T was leaning over the trash can throwing something away and Jessica was lying flat on her back in bed, spread eagle, completely uncovered, and sitting in a big puddle.  It took me a few seconds to piece together what had happened.  Turns out Dr. T was throwing away the amniohook he used to BREAK Jessica’s water WITHOUT me being in the room!  I quickly stepped towards the bed to raise her head and cover her up.  The entire bed was soaked.  It was getting harder and harder for me to contain myself and I could feel the blood boiling up into my head. 

     

    Me:  “What’s going on?”  (said in the nicest voice I could muster up)

     

    Dr. T:  “Oh, are you taking care of Jessica today?”

     

    Me:  “Yes.”

     

    Dr. T:  “Well, I just got out of the OR and I wanted to check her progress and apparently the residents hadn’t ruptured her yet!  So I just did.”

     

    Me: “Oh, well, what nurse came in here with you?  I’d like to thank her.”  (also said in the nicest voice I could muster up but clearly my sarcasm was piercing through all my attempts to stay calm)

     

    Dr. T:  “No, it was just me.”

     

    Me:  “Oh really, well you should have come and got me.  I would have been more than happy to assist you.  It would have liked to lay some more chux pads down under her so that when you broke her water it wouldn’t cause so much of a flood.  I’m going to have to change all the sheets now, all of them.  And what if the baby had a decel…”

     

    Dr. T:  (interrupting me)  “Well I couldn’t find you.”  (turns towards Jessica)  “I’ll come back in a couple of hours to check you.”  (turns to walk out of the room and then spins around and turns towards me)  “Why is her pit only at 8mu?”

     

    Me:  “Jessica didn’t even get to the hospital until 1:30 and policy states we can’t start pitocin until the patient is fully admitted.”

     

    Dr. T: “Well she’s still only 4cm so you are going to have to keep going up on the pit if she is going to get anywhere.”  (This statement really takes the patient right out of the equation doesn’t it!  Outrageous!)

     

    Me:  “What’s the baby’s station?  Is the baby still high?”

     

    Dr. T: “Um yes, but the head is now well applied.  She’s 4cm/50%/ -3…..maybe -2.”

     

    At this point all I can think of is “Liar, liar, liar!”  Dr. T turned to leave the room and after he left I assisted Jessica out of bed to the bathroom so that I could change all of her sheets and help her into a new dry gown. 

     

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    I need to digress for a moment to explain exactly how outrageous it was for Dr. T to check the patient and rupture her membranes without me or any other nurse in the room.

     

    #1 Although this might seem like a silly thing to be upset about, the fact that he ruptured her membranes without even putting down a few extra chux pads (which were sitting right on the counter) is very rude in my opinion.  It’s like saying “You clean up my mess because I am above that.”  Honestly it wasn’t that difficult to change the bed over and help the patient into a new gown but it’s the principle of it that bugs me.

     

    #2  It is an unwritten rule at my hospital that a nurse is to accompany any doctor or midwife during a vaginal exam.  Even the residents are taught this during orientation.  Is a doctor or midwife fully capable of performing a vaginal exam solo…of course they are!  But it isn’t about that.  It’s mostly about touching base with the nurse first to see how things have been going all shift with the patient.  It’s about good communication and team work.  And sometimes another vaginal exam isn’t necessary and the nurse can advocate against it!!!  I haven’t met one doctor or midwife that attends births at my hospital that has a problem with this arrangement….unless they are trying to do something that they know the nurse will question them on….like performing an early amniotomy on a patient whose baby is still high!!  The fact is that that is the ONLY reason Dr. T didn’t come and get me…because he knew that I, and many other nurses, would question the necessity and safety of such an intervention.  So he had to SNEAK it.  What he did was so SNEAKY and it infuriated me! 

     

    #3  The other most important reason to obtain the assistance of the patient’s nurse (or ANY nurse at the desk really) is just in case something bad was to happen.  Although something acutely bad is unlikely to happen from just a vaginal exam, the nurse’s role in assisting with the vaginal exam is to maintain the patient’s comfort and protect the patient’s modesty.  (As you can see, Dr. T did none of those things, and things like that happen a lot with some of the docs I work with.  All of the pregnant readers I know understand how uncomfortable it is to lay flat on your back for any length of time when you are pregnant!)  But there ARE acute risks with performing an amniotomy, especially an early or prelabor amniotomy. 

     

    Risks related to amniotomy that have emergent consequences include:

    1)     Umbilical cord prolapse

    2)     Fetal heart rate decelerations related to umbilical cord compression

    3)     Change in presenting part

     

    Let me give you an example.  One time I had a doctor that ruptured a patient with polyhydramnios and a high presenting part.  (That means, the baby’s head was not well engaged into the pelvis and was still “floating”.)  After the gush of water flooded the bed, the baby started to have pretty serious heart rate decelerations with every contraction related to compression of the umbilical cord.  When the doctor did a vaginal exam to check her dilation, he found that he was no longer feeling a head, but a HAND.  Since the baby was high and floating in a large amount of fluid and the head was not well engaged when he ruptured her membranes, the first thing to rush out was the baby’s hand.  The doctor was unsuccessful at moving the hand back.  And that woman, a grandmultip (G6P5) who had had FIVE previous spontaneous normal vaginal deliveries ended up with an emergency cesarean section.  And it was VERY IMPORTANT that I was in the room when all of this happened since I was the one who ended up almost single handedly assisting her into knee chest, throwing on some oxygen, and wheeling her down to the OR as the doctor rushed to scrub in.  Yes, emergencies can happen that fast.  (This one however was almost completely avoidable!!)  Please know that I am not telling this story to scare anyone.  But the LESS interventions you have, the significantly LESS chance you have of that kind of emergency happening.  And if a physician or midwife is going to take the chance with any intervention like amniotomy, it is very important that he or she has assistance from a nurse in the room. 

     

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    Okay, thanks for letting me rant there for a minute.  Back to the story…

     

    So after I helped Jessica clean up I offered to help her out of bed into any position she liked.  After all, it’s important to use gravity to help you and not work against you!  Jessica decided that she wanted to get up into a rocking chair.  I continued to titrate the pitocin to obtain an “adequate” contraction pattern.  Jessica’s body was actually pretty resistant to the pitocin so I ended up eventually getting all the way up to “max pit,” or 20mu/min, around 6:00pm.  Jessica was contracting about every 2 ½ -3 minutes each lasting for about 40-60 seconds.  Jessica complained most about her back pain and so we tried a variety of positions to ease this for her including using the rocking chair, standing at bedside, birthing ball, back rubs, slow dancing etc.  Jason was an excellent birth coach and the two of them really worked well together.  Jessica did not feel comfortable walking in the halls (some women prefer a bit more privacy and I can’t really blame them!) so she did a lot of pacing in the room.  Around 6:45pm, Jessica was getting really tired and asked if she could get back in bed.  We tried a few positions in bed (side lying, kneeling, etc.) but the back pain was too intense. 

     

    I wished at that moment we could have gotten her into the Jacuzzi but despite what some other people might tell you, trying to continuously monitor a patient in the Jacuzzi is almost impossible, especially since there are no monitors in the tub room at my hospital so I cannot see or hear what the baby’s heart rate is doing when I am in there manually holding the monitor to her belly so the bubbles don’t knock it off.  This is yet another reason why back door inductions frustrate me.  If she was in true labor and not on pitocin, I could have done intermittent auscultation which is very compatible with using the Jacuzzi.  Some women think they can have it all (for example their induction and the Jacuzzi).  But fact of the matter is that agreeing to an unnecessary induction automatically makes a natural birth plan harder, NOT impossible, but harder. 

     

    Turns out the only position that Jessica liked at that time was sitting straight up in bed, leaning forward on the squatting bar, with the foot of the bed lowered so the bed looked like a “chair.”  She was moving and breathing very well in this position with Jason and me as her coaches, and she seemed to start to drift off into “Laborland.”  At 7:00pm Dr. T came into the room and stated he was going to do a vaginal exam to check for progress.  Jessica had started to complain of some intermittent rectal pressure so I had assumed that the baby had moved down some.  Turns out she was 5cm/100% effaced/-1 station!!  “This is great!,” I said to Jessica, “You are doing such a great job!  Not only are you 5cm now but you have thinned all the way out AND you have moved the baby down a lot!!  You are doing so well!!” 

     

    Both Jessica and Jason seemed excited about the progress which is great because I was afraid that Dr. T would say something annoying like “Oh bummer, you are only 5 cm.”  But the truth is that in order for your cervix to dilate you have to thin out first and therefore progress in effacement and station are also signs of great progress, not just dilation. “Do you want anything for pain?,” asked Dr. T.  “No, not yet, I want to try to go longer,” she replied.  Jessica spent the next two hours sitting straight up in bed, leaning over the squat bar, with the bed in the “chair” position.  Jason was standing beside her rubbing her lower back while I was helping her to stay focused on her breathing.  She had a couple mini “freak outs” like “I can’t do this anymore!,”  “This is it, I can’t take one more contraction!”  “How much longer is this going to be?!”  What is important to remember is that these “freak outs” are NORMAL and it doesn’t mean you are weak or a wimp.  Far from it!  Labor is one of the most intensely physical experiences of your entire life.  It is comprised of sensations that are unlike any others you have felt before.  And that is why positive encouragement is so important.  I know it is hard to see someone you love in pain but Jessica had said she did not want any pain medication or an epidural at this point so providing her with unconditional support was what was needed.

     

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    A quick story…

     

    When I used to run cross country in high school we would often have “distance days” were our workout consisted of running a 13-18 mile long run.  We would start right after school and often not get back until it was dusk.  Those runs were grueling especially since we lived in a very hilly town.  I remember thinking or saying things like “I can’t do this anymore!” or “No, just go on without me!”  I remember feeling so many times during those runs like I wanted to “quit” and walk.  But I knew that if I did, it was just going to take me that much longer to get home.  And one of the things that kept me going the most was the support from my teammates.  “Just run until that phone pole” then “just run to that fire hydrant” then “just run to that stop sign.”  I got through it because I took it one small stretch at a time.  When I thought about how much farther I had to go, when I thought about the whole run as a whole, the task at hand seemed overwhelming and insurmountable.  But when I took it “one phone pole at a time” I felt like I could handle it.  There was no other way to get home but to run.  And it hurt.  And the cramps in my sides made it hard to breathe.  And sometimes I would have to lean over into the woods and throw up.  Every bone and muscle ached, from my ears to my toes.  I remember my knees stinging with each footstep.  But there was no other way to get home but to run….  And when I finally crossed onto the track at the high school to run the last stretch I felt like I could do anything.  I did it! 

     

    I am not trying to claim that running a long run is exactly like labor.  For one I was only running for a few hours, not hours and hours and hours.  And I knew exactly how much I had left, unlike moms in labor.  And genital pain was not involved at all!  Haha!  But the point is that a great mix of positive encouragement from my teammates, self determination, and the technique of taking it one step at a time was the reason I succeeded.  If my teammates just left me in the dust every time I said “Just go on without me!  I have to walk” then I wouldn’t have been as successful and I wouldn’t have gotten as much out of the run.  So ladies, it’s NORMAL to “freak out” a bit, which is why surrounding yourself with positive, helpful, and supportive coaches (not just “specators”) is so important, ESPECIALLY in a hospital birth.

     

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    Jessica labored like this for about two more hours.  She was definitely in Laborland, kinda spacey, like she was in a trance.  At around 9:00pm Jessica said that she was feeling a lot more rectal pressure and wanted an epidural so I went out to the desk to page a resident.  Lucky me Dr. T happened to be sitting at the main desk chatting with another doctor.  I told him that Jessica would like to be checked to see how far along she was because she was considering an epidural.  He came into the room and low and behold, she was 6cm/100% effaced/ 0 station.  Woohoo!  Jessica stated she wanted the epidural so I proceeded to get things set up so that we would be ready when anesthesia came in.  I had already reviewed with her the risks and benefits of an epidural earlier on (when she was more comfortable), so now I just had to explain to her what to expect from the procedure. 

     

    After setting up the room I walked out to the desk to see how long it would take anesthesia to see her.  Turns out that anesthesia was tied up in a cesarean section so Jessica would have to wait.  (Unfortunately, even in a hospital that has 24/7 anesthesia like mine, they are not always available for epidurals.  So if this is your only reason for deciding to have your baby at a high-risk hospital, I would make sure you review all of your options.  And if your only labor preparation is deciding you want an epidural, it is imperative that you prepare for the possibility of not getting one!)  When I was at the desk, I checked the orders to make sure Dr. T had written for the epidural.  And that’s when I found his progress note:

     

    X/X/XXXX

    2115

    S: Complains of more pain, wants relief

    O: Cervix 6 cm dilated, completely effaced, 0 station

         EFM shows Ctx every 3 min x 60, baseline 140, +accels, Æ decels, moderate variability

    A: Active phase labor with unsatisfactory progress

    P:  Anesthesia notified for epidural

         Recheck in one hour, if no significant progress, anticipate primary cesarean section for arrest of dilatation

                                                                                                  Dr. T

     

     

     

    I was floored.  I couldn’t believe he was basically already throwing in the towel for Jessica.  It was her first baby for goodness sakes!  Babies come in their own time!  I mean, she hadn’t even gotten the epidural yet and the pitocin has to be shut off for the epidural so by the time the “hour” was up, it would have been completely unfair to expect her to have made any “progress.”  And what does that mean anyways?  So I called him out on it:

     

    Me:  “Dr. T.  You are already throwing in the towel for her!?  Why does the plan even mention a cesarean at this point?!”

     

    Dr. T:  “You’re kidding right, she has only changed 2cm in the last 7 hours.”

     

    Me:  “Well that’s not really true because I didn’t even get her contractions into an adequate pattern until about 6pm.  And it’s her first baby.”

     

    Dr. T:  “Jeeze, you call that progress?!  I can’t be here all night you know…”

     

    (YES he really did say that.  This is also the doctor that told me once to tell a multip who was 8cm and feeling pushy to “Not push” because he wanted to finish the ice cream he had just ordered with his wife and kids.  I mean, I’m all for him spending time with his kids but he was ON CALL and this was a third time mom who was feeling RECTAL PRESSURE and was 8 CM!  There is NO telling her “Don’t push!”  It’s called the fetal ejection reflex for goodness sake!  And guess what, not only did he missed the delivery, but he then chewed me and the resident out for it.  I’m not making this up…In fact I can’t make this stuff up!)

     

    Me:  (getting pretty upset but trying not to scream at him)  “Are you kidding me!  She wasn’t even in labor when she got here!  If she was, you wouldn’t have started her on pitocin.  She wasn’t even in labor!  You didn’t have to be here at ALL but YOU were the one who sent her in for induction.”

     

    Dr. T:  (smirking)  “Induction!  She was 4cm!”

     

    Me:  “But she couldn’t feel any of her contractions!  And now you are just going to cut her without at least seeing if the epidural helps?!  This is her first baby!  This delivery has consequences for the rest of her life!”

     

    I was afraid I was going to strangle him at this point so I just left the desk to go back into the room.  Anesthesia didn’t show up until 10:30pm and at 11:00 pm Penny, the night nurse, came in to take over.  I stayed until the epidural was finished and tucked her in.  The next day I got the full scoop on what happened from Penny and the patient’s chart.

     

    Apparently Jessica got great relief from the epidural and slept like a rock for 2 hours.  Luckily the baby tolerated the epidural well and remained happy on the monitors. Dr. T must have fallen asleep in his call room or gotten distracted because he never came back to check her.  At 1:30am Jessica woke up feeling a lot more rectal pressure.  Penny called the resident to check her and her exam revealed she was fully dilated (HOORAY!!) but that the baby was still at a 0 station.  Since the resident was busy with other patients she agreed, per Penny’s request, to NOT call Dr. T and wake him up but rather to shut off the epidural, allowing it to wear off a bit, and use passive descent to help get the baby down more before they started pushing.  (Although Jessica was feeling more rectal pressure, a practice push revealed that she could not feel her bottom enough to push.  If she had started to push at that time, she would have just tired herself out).  Also, Penny knew that Dr. T was notorious for only “letting” patients push for about an hour (even if they can’t feel their bottom) and then if the baby isn’t out he performs a cesarean for “failure to descent.”  Phooey! 

     

    One hour later at 2:30am Jessica was feeling an uncontrollable urge to push and a vaginal exam by the resident revealed that she was 10cm/100%/ +2 station!!  Yay!!  Penny said that she felt it was best not to make Jessica wait for Dr. T to rise and shine so she instructed Penny to push whenever she felt she needed too.  She said that Dr. T didn’t even make it into the room until about 10 min before Jessica pushed out her 8lb, 6oz baby boy at 3:05am after only approximately 30 minutes of pushing!!!!  The baby was also found to be in an occiput posterior position, which explains all that back pain Jessica was experiencing and perhaps the length of her labor as well.  Dr. T did cut an episiotomy but the baby delivered before he could get his hands on a vacuum J.  According to Penny, baby Christopher James nursed like a champ and stayed skin to skin with mom for almost a whole two hours! 

     

    Fortunately for all those involved, Jessica and Jason’s story had a wonderful ending!  However, despite the fact that Jessica’s birth did not end in a cesarean section doesn’t mean that there were not many injustices in the way her care was managed by her birth attendant.  Stories like this always get me thinking…what if?  What if Jessica had been sent home from the office instead of sent in for a back door induction?  Would the baby have eventually turned around so that he was no longer occiput posterior?  Would her natural contractions been easier to handle and therefore would she still have opted for the epidural?  If she was not induced with pitocin and therefore not required to be on continuous monitoring, would the freedom to move around more in labor and the ability to use the Jacuzzi tub helped to alleviate her back pain if the baby stayed occiput posterior?  What if she had had a different nurse that encouraged her to get the epidural earlier on?  What if Dr. T had gotten his way and started to make the patient push before she had regained use of her legs and feeling in her bottom?  What if Dr. T had kept her membranes intact until much later in the labor?  What if Dr. T had checked her one hour after she was found to be 6cm and she hadn’t made “satisfactory progress”….would she have been given a cesarean for “failure to progress?” 

     

    In summary, I would just like to say that unlike what many OBGYNs, nurses, friends, family members, moms, journalists, etc will tell you, the journey matters just as much as the outcome.  The fact is that women truly amaze me no matter how they give birth.  Whether it is a natural home birth or a scheduled cesarean section, the bottom line is that women have superpowers!  They can grow people inside of them after all!!  And my greatest wish is that all women will feel in control of the decisions regarding their birth and in the end feel empowered no matter the mode of delivery.  But as a society we have to be more conscious of how our overly medicalized maternity care system affects the thoughts, feelings, and emotions of our patients and families as well as their outcomes.

     

    Don’t Let This Happen To You #24 PART 1 of 2: Jessica & Jason’s Back Door Induction April 13, 2009

    Continuation of the “Injustice in Maternity Care” Series

     

    Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?!  Are you SERIOUS!?  Oh come ON!”  Because of this I was inspired to start the “Injustice in Maternity Care” blog series, or more appropriately the “Don’t Let This Happen to You” series.  If you are pregnant or planning on becoming pregnant, this series is dedicated to you!  If haven’t already read it, I invite you to check out the first addition to the countdown: DLTHTY #25: Sarah & John’s Unnecessary Induction

     

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    There are so many things about the current state of maternity care in the United States that frustrate, infuriate, sadden, and annoy me but one particular thing that really gets my goat is the back door induction.  As you might have already read, I am a labor & delivery nurse in a large urban hospital and we are BUSY!  Although I know there are hospitals that way more deliveries a year than we do, for the capacity of our hospital, 4500 deliveries a year is almost more than we can handle with our current facility and staffing.  (By the way, 4500 deliveries a year breaks down to about 375 deliveries a month and about 12 deliveries a DAY!  (Jeeze, I am exhausted just looking at the statistics!) 

     

    One way to help organize all the chaos is to have an induction book in which doctors have to schedule all of their inductions at least 24 hours in advance.  This way we have somewhat of an idea about appropriate staffing and room assignment for our patients for each day (in theory).  (The exception to this rule is the induction in which there is a documented medical reason related to either mom or baby’s health that requires an urgent delivery of the baby.  For example, severe intrauterine growth restriction (IUGR) with a non-reassuring nonstress test (NST) and biophysical profile (BPP) or worsening preeclampsia.  We obviously don’t make these mom’s sign up for a spot.  They are usually a direct admit from the office to the hospital.) 

     

    However, when a doctor is either lazy, anxious, rushed, or overall feels he is above the rules, he (or she) will send a patient in from the office as a direct admit to the hospital for labor when she actually is NOT in labor and will the proceed to INDUCE her under the guise of augmentation.  When providers do this, it increases the amount and acuity of our patient census and puts an unnecessary strain on our staffing which compromises the amount of individualized care we can give to our patients.  What these doctors don’t tell you is that inductions can take up to three days to complete!  If you are truly in spontaneous natural labor, even a slow labor, you won’t be in the hospital for 3 days.  Inductions take MORE time, MORE money, MORE staff, MORE resources and hence are MORE risky.  Let’s digress for a moment so that I may clarify the difference between induction and augmentation:

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

     

    Labor: Regular, noticeable, and painful contractions of the uterus that result in dilation (opening) and effacement (thinning) of the cervix.  Therefore if you are having regular uterine contractions that are noticeable or even painful but are not making any change to your cervix, it is NOT labor.  Likewise if your cervix is dilated and effaced but you are NOT having uterine contractions that are noticeable and painful then you are NOT in labor.  (Note: I have had low intervention doctors and midwives send multips (a woman who has given birth at least once) home at 4 or 5 cm if they are not having any contractions or not changing their cervix.  One particular patient I can remember was a G5P4 and was 5cm dilated when she came to the hospital.  We kept her for 4 hours but she never changed her cervix…she couldn’t even feel her irregular contractions and she was comfortable.  So she was sent home.  Two weeks later she came back 8cm dilated in hard labor and I assisted with her very quick birth.  She did amazing and the baby was happy and healthy!  Clearly, even at 5cm, she wasn’t in labor.)

     

    Induction: the use of medications or other methods to start (induce) labor before the woman’s body has spontaneously begun true labor on its own.

     

    Augmentation: stimulating the uterus with medications or other methods during labor that has already begun naturally to increase the frequency, duration and strength of contractions, the goal of which is to establish a pattern where there are three to five contractions in 10 minutes, each lasting more than 40 seconds. 

     

    So just to be clear (and to adequately set up my story) if a woman is 4cm dilated but is not having regular, noticeable, and painful contractions that are causing cervical change she is NOT in labor.  If said woman is sent into the hospital and any interventions to stimulate contractions are started, then it is by definition considered an induction NOT an augmentation.  And if said patient was not scheduled to be admitted on such day, then it is considered a backdoor induction.   

     

    Let’s continue with the story…

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

     

    It was a Friday morning before my weekend off and I came in to work at 11am as usual.  I was looking forward to the weekend since it had been a really busy week and I was exhausted.  For the first four hours of my shift, I triaged a few patients but ended up sending them all home for one reason or another.  As I was finishing up some paperwork at the desk around 1:00pm, Dr. T came off the elevator and over to the nurses station.  I overheard him telling the charge nurse that he was just at his office and was sending over a primip (a woman who has never given birth) for us to admit for labor who was 4cm dilated/50% effaced/-3 station by his exam in the office.  He then slinked towards one of our second year residents who, in my opinion, will definitely be joining the ranks of the aggressive labor management elite, and uttered, “I’m sending over a patient from the office, 4cm.  Could you break her water when she gets here and start her on pit.  I know you’re the only one who will do it.  The baby is still high.”

     

    Situations like this one are exactly the reason why I shouldn’t eavesdrop!  The reason why Dr. T was concerned that “no one else” would break her water was that when a baby is at a minus 3 station and is “too high,” if the membranes are ruptured artificially the umbilical cord could slip down before the baby’s head, getting pinched between the baby’s head and the cervix, cutting off all blood flow from the placenta to the baby.  This is called a cord prolapse and it is a surgical emergency requiring an emergency cesarean section.  This emergency is very unlikely if your water breaks naturally at term during labor because typically when it happens naturally the baby’s head is well applied to the cervix which puts pressure on the bag causing it to break.  I wanted to turn around and shout at Dr. T, “If you are so concerned “no one else” will take the chance, why won’t you do it yourself?!  Is it really so wise if it is so unsafe?”  Furthermore, the thought of sending over a patient for “labor” and then immediately starting her on pitocin and breaking her water makes my head feel like its going to explode!  If she is really in labor then she does NOT NEED pitocin!  And if she “needs” pitocin, then she is NOT in labor!  This is a BACK DOOR INDUCTION and ladies, it happens all the time.  Think about it, it was a Friday and Dr. T happened to be on call that weekend.  Looks like he didn’t want to get a page over Sunday brunch that one of his patients was in labor!  AHHHHHHHHHHHHHHHHH! 

     

    Sorry, I lost it there for a minute J.  But it is just these kinds of injustices that make my blood boil!  Let’s continue…

     

    Come change of shift at 3pm I was patient-less since I had sent all my triages home and hence was assigned to the patient in room 9.  And guess whose patient it was!  None other than Dr. T’s “labor” patient!  Oh brother!  This was going to be an interesting night! 

     

    From report I got most of the details:  Jessica was a 25 year old first time mom (G2P0) just a few days past her “due” date (40 weeks and 3 days).  Here health history was unexceptional: exercise induced asthma as a child that did not require any medications, tonsillectomy at age 7, and one miscarriage at 5 weeks two years ago.  Her pregnancy was normal, healthy, and uncomplicated.  The patient had arrived to the hospital at 1:30pm with her longtime boyfriend Jason.  Jessica’s day shift nurse had completely admitted her and started her on pitocin but because the floor was crazy busy all day, she had only gotten the pitocin up to 4mu/min and the residents had only gotten the chance to write orders and not to rupture her membranes.  (My thought = Yes!!)  [Note: For a description of how pitocin is administered check out: Don’t Let This Happen To You #25 PART 2: Sarah & John’s Unnecessary Induction].

     

    Next I went into the room to meet Jessica and Jason.  Jessica was a bubbly young woman with big rosy cheeks.  Her boyfriend Jason was living proof that you can’t judge a book by its cover.  He was super funny and down to earth and very supportive of Jessica in every way, yet a bit intimidating at first because he was almost completely covered in tattoos and had multiple facial piercings J.  They looked like total opposites and yet were so perfect for each other.  We chit-chatted for awhile and really seemed to hit it off since we all had the same sense of humor.  I took the opportunity to satisfy my curiosity about how Jessica had ended up in the hospital since she seemed very comfortable the whole time we were talking.  The monitor strip revealed that she was having contractions about every 6-8 minutes but she was not even flinching as I saw them come and go on the monitor.  To gain a bit more information I started to ask some questions.  I kept the conversation light in tone, like “So tell me about your day today?” instead of “Why the heck are you here!  Run!  Run away!!”  J  Here’s our conversation:

     

    Me: “So how did you end up at the office today?  Did you have a scheduled appointment or were you having contractions?

     

    Jessica: “No I was feeling great!  I had a scheduled appointment and when they put me on the monitor for a non-stress test, the nurses told me that I was having contractions!  It was so crazy because I didn’t even know I was having them!  So then Dr. T decided to check me since I was contracting and I was 4 centimeters!”

     

    Me: “Can you feel any of your contractions now?”

     

    Jessica:  “I think so, well, am I having one now?  Wait, no, maybe now?  (Looks towards monitor) Yeah, I am having one now.

     

    At this point I’m thinking: If you have to look at the monitor then the answer is no, no you are not feeling contractions!  Sometimes I turn the monitor screen off so the patients or family members can’t “contraction watch.”  J

     

    Me: “So what happened next?  Did Dr. T tell you to come right over or did he say you could go home first?”

     

    Jessica:  “He said we could go home first and get our stuff together but not to “dilly dally” because they were waiting for us here.  So we rushed home and grabbed our bags.  Good thing we packed last week!”

     

    Me:  “Yeah, it’s great you were prepared.  What did Dr. T tell you the plan was for when you got here?”

     

    Jessica: “He said that once we got here that he would break my water but they haven’t done that yet.  I guess it’s really busy today, huh?”

     

    Me:  “Yeah, It’s a busy day.  Did he say anything about starting you on pitocin?”

     

    Jessica:  “He mentioned that I might ‘need a little pitocin’ because my contractions weren’t in a regular pattern and were pretty far apart.”

     

    Me:  “I bet it was a big surprise to you to be induced today, huh!”  (I couldn’t help myself!)

     

    Jessica:  (confused)  “Well I didn’t expect to find out I was in labor today  that’s for sure!”

     

    Me: “Do you guys have a written birth plan or any thing I should know about regarding your labor and birth preferences?”

     

    Jessica:  “No nothing written.  Well, I wanted to try to go as natural as possible.  I don’t want any narcotics and I don’t think I want an epidural.  I mean, I’m not ruling it out, but I really want to go as naturally as possible……………I mean, I guess that’s not totally going to happen now because I am on pitocin but, well, you know…”

     

    (Yes!  The “in” I’ve been waiting for! Sometimes I wish I could tape patients and then play back what they say to me to see if once they hear it back, they then realize how illogical their doctor is.  I mean sometimes I feel like a mom who has to sneak spinach into her kids’ favorite foods to trick them into eating vegetables.  I can never just come out and say my intentions, I have to play this “game” and hope they figure it out themselves.  This is something of a daily internal struggle for me.)

     

    Me:  “Well that is not necessarily true because although we are limited by the fact that with the pitocin running I have to have you on the monitors, as long as I can trace the baby’s heartbeat I can help you into any position that makes you most comfortable.  Unfortunately pitocin is not a good as the “real” thing you know? What I mean is it makes contractions artificially stronger and longer than natural contractions.  But I will do my best to titrate the pitocin so that we get an effective labor pattern that both you and the baby can tolerate well.  We can all work as a team, sound good? J

     

    Jessica & Jason: “Yeah sounds good!”

     

    I’m sure, my savvy reader, you have already recognized why I started this post with the difference between induction and augmentation!!  The TRUTH is: If you are at term and someone has to “tell” you that you are “in labor” then you are NOT in labor!  I just feel so badly for these women!  I truly don’t think it is their fault!  I think that they put all their trust in their birth attendant and most of the time are just naïve and don’t know any better.  And I don’t say that to be patronizing, I say it out of love and concern.  And as I mentioned in the first post of this series, I don’t want to start off my first interaction with these patients by going off on a tangent about unnecessary induction because I don’t want to make them defensive, doubtful, untrusting, or upset because these emotions do not facilitate labor!

     

    *Sigh* 

     

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    Up For Next Time: Don’t Let This Happen To You #24: PART 2 of 2 

     

    Read about Jessica’s labor, the birth of her baby, and Dr. T’s upsetting prediction about her birth too early in the game.

     

     

    (Research for this post was aided by my trusty OB textbook from nursing school:  Maternal-Child Nursing (Second Edition) by Emily McKinney, Susan James, & Sharon Murray Ó2005)

     

    My (Aggravated) Response to “Ban the Breast Pump” April 3, 2009

    Hanna Rosin’s done it again.  It was bad enough that she was even published never mind the fact that she was actually invited onto NBC’s Today show.  But now there are journalists out there seriously supporting her cockamamie ideas and poor research by writing about her in major news papers!  Oh give me a break!

     

    Case in point: April 2nd’s edition of The New York Times.  Gracing the opinion page, an article entitled “Ban the Breast Pump” by Judith Warner, author of the 2005 book “Perfect Madness: Motherhood in the Age of Anxiety.”  Oh brother… this should be good. 

     

    Warner begins the article by quoting Rosin in a recent four-part controversial podcast conversation she has filmed with three of her gal pals.  The main target, among a host of other things, is the breast pump.  Quoting Rosin, “That was my least favorite thing I ever did in my whole life.  Who could blame [your husband] for never wanting to sleep with you again?

     

    Oh jeeze, and here Warner goes… This is what she had to say in regards to watching Rosin’s podcast and reading her Atlantic article, “Hallelujah, I all but shouted at the computer, desperate to join in the conversation with these newfound sure-to-be best friends.  Rosin’s article, based upon a review of the relevant medical literature and some physician interviews, makes the case that the health claims about breast milk have been greatly overstated.  Why have we made such a fetish of breast milk when there’s no evidence to prove whether, as Rosin puts it in the Atlantic video, ‘what’s key about breast feeding is the milk or the act of breast-feeding’?”

     

    If all of this is not infuriating enough, Warner decides to end her article with the following “take that” to every nursing mother out there who for one reason or another, desires to, has to, and likes to use a breast pump:

     

    “In fact, I hope that some day, not too long in the future, books on women’s history will feature photos of breast pumps to illustrate what it was like back in the day when mothers were consistently given the shaft. Future generations of female college students will gaze upon the pumps, aghast.  ‘Did you actually use one of those?’ they’ll ask their mothers, in horror.  And the moms, with a shudder, will proudly say no.”

     

    Of course I am not so naïve to think that there aren’t some women out there that don’t particularly enjoy, maybe even hate, using a breast pump.  I can remember my best friend telling me stories about when she was pumping for her premature twin girls when they were in the NICU.  She told me that it was very important for her to provide the girls with her breast milk since they were so premature, the gift, she said, of added germ fighting power she knew only she could provide for them.  But a month was her limit and she has said to me how she does not miss “milking” herself and how hard it was to “warm up” to a breast pump when she was so sad her babies were not at home with her.  I can totally understand her feelings.

     

    On the other hand, I remember my mom pumping breastmilk for my three brothers and sisters before working evenings as a waitress while I was growing up.  So I called her up today and asked her how pumping made her feel.  “It didn’t much bother me,” she said, “It actually was pretty quick when I used to do it and I was lucky enough that I only missed one feeding being at work.  But if I didn’t have that pump, boy, that would have made things more difficult.”

     

    First of all, it really boggles my mind that Warner can write, “Why do we, as women, accept all the guilt and pressure about breast-feeding that comes our way instead of standing up for what we need in order, in the broadest possible sense, to nourish and sustain ourselves and our families?” and yet be SO BLIND to the reality that there are hundreds of thousands of mothers in this country and in the world that DO NOT believe that breastfeeding is a burden, plaguing their marriage and self esteem, and hurting their independence and career!  That she can be so PIG HEADED to oversee how, for many families, breastfeeding is the ONLY way they CAN or CHOOSE to nourish and sustain themselves?!  And NEWSFLASH!  The real truth is that there are many mothers out there that breastfeed, not because they feel guilt if they don’t or feel societal pressures to do it, but that it is the best choice for them and their families.  Rosin & Warner’s stance falsely gives their readers the impression that all of the breastfeeding moms out there are just waiting for someone to give them an “out.”  How ignorant!

     

    The following is an incomplete list of reasons that a mother might NEED, CHOOSE, or WANT to express their breast milk with a breast pump:

    1)     Their own milk supply is higher than their baby’s needs and not pumping causes their breasts to become uncomfortably full

    2)     Their own milk supply is less than their baby’s needs and pumping is required to build up a bigger milk supply (the physiology is: the more a mother breastfeeds or pumps, the more milk she will make)

    3)     Breastfeeding must be delayed after the birth of a premature baby or sick baby that does not yet have the ability to coordinate a suck and swallow motion and therefore must be fed via gavage feeding (tube in stomach) and not pumping would render the mother with out an adequate milk supply to start breastfeeding when the child is ready.  Not to mention the proven evidence of how beneficial breastmilk is for a premature baby.

    4)     The mother must be away from the child at some point of the day/week (for example, when she returns to work), and wishes to provide the baby with breast milk via bottle feeding when she is unavailable.  Pumping also allows the woman to keep her milk supply adequate especially if she works full time or long shifts.

    5)     The father desires to participate in feeding the baby and both parents desire that the feeding provided still be breastmilk

    6)     The mother would like to build up a supply of milk that can be frozen and used during a night out or in any situation where the mother might have to be away from the infant.

    7)     The mother is experiencing engorgement after delivery causing the mother’s nipples to become flat and the skin on her breasts to become taut, making it difficult for the baby to latch on properly.  The temporary expression of milk with the aid of a breast pump can soften the areola so that the baby can latch on properly and hence, remedy a situation that could potentially threaten the mother’s confidence in her breastfeeding ability.

     

    So as far as banning the breast pump goes, I think that it is one of the most judgmental, unsupportive, ignorant, selfish, and detrimental suggestions to come out of this whole “The Case Against Breastfeeding” debacle.  And articles like Warner’s are only the beginning. 

    (See: Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding)

     

    Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding) March 18, 2009

    The Today Show hurts America.  That’s right.  And while I’m at it, so does Good Morning America, The Early Show, Fox & Friends, and every other American morning “news” and talk show that propagates careless, partial research and half-truths.  And Monday, it got personal. 

     

    The American media has been finding itself in a heap of trouble lately.  First it was the political media that failed us by not accurately and truthfully reporting the state of events leading up to the war in Iraq.  Then it was the economic press, failing to appropriately and honestly alert us to the foreseeable consequences to greedy and dishonest deeds on Wall Street and in corporate America.  And now it’s the morning news/talk show circuit (and I use “news” lightly) that is flooding American homes with irresponsible, half-assed, and poorly researched segments that can have a profoundly negative impact on the breastfeeding culture as we know it.

     

    Case in point, Monday’s segment titled Is breast-feeding really best?: The case against breastfeeding, hosted by The Today Show’s Natalie Morales, advertised with the tag line, “Some women are questioning whether the health benefits are worth it.”  When I saw this segment and read the “supporting” article on www.today.msnbc.com I honestly started to cry; my entire being was deeply saddened by the potential negative consequences this garbage could have on impressionable gestating and new mothers all over this country.

     

    The segment starts by citing the American Academy of Pediatrics recommendation that mothers breastfeed their children exclusively for the first 6 months and continue to breastfeed while introducing solid foods for the first year.  After this, the segment goes downhill fast.   Dr. Nancy Snyderman, NBC’s chief medical editor, continues by apathetically listing an incomplete inventory of the health benefits of breastfeeding for both babies and mothers and then states (and this is a direct quote), “But some challenge the science is not so strong.”  [I will get to that outrageous untruth in just a moment.]

     

    Next to speak is Hanna Rosin, a breastfeeding (that’s right) mother of three who recently wrote an article for the current issue of The Atlantic magazine entitled The case against breastfeeding.  Morales prompts Rosin with the statement, “You are not anti-breastfeeding but you do talk about the society pressures.  Explain,” to which Rosin responds, “New moms are really vulnerable.  You go into the doctor’s office, you read the magazines, and they make you feel like you are putting your child in grave danger if you don’t breastfeed them.  And then you read the scientific literature and frankly, there isn’t the solid evidence you would expect to support this.”

     

    Let’s take these outrageous statements one at a time shall we! 

     

    Bogus Claim #1 I believe Rosin is right when she says that new moms are vulnerable and because of this, I feel like we should be using our resources and energy in this country to increase support for pregnant and postpartum moms instead of going on television and touting why one shouldn’t breastfeed!  In fact, pregnancy is a time when most women find themselves really starting to form a healthy obsession with researching everything they can about pregnancy, birth, and child rearing.  And that is good! We have come a long way from the 1950s when women were given hormone injections to dry up their milk, left alone as their babies were taken from them for hours or days after birth, told that their breasts were either “too big” or “too small” to breastfeed, or worse, that breastfeeding was only for “poor” or “uneducated” women.  It is sad that Rosin does not see how wonderful it is that magazines and physicians are finally on board with reporting on the benefits of breastfeeding and how to be successful at it!  And if those articles make women feel “bad” about choosing not to breastfeed, that doesn’t mean that these articles are bad, it might just mean that these particular women might need more education and support during pregnancy and postpartum.

     

    Bogus Claim #2 As far as there not being enough scientific literature supporting the benefits of breastfeeding, how about this: a meta analysis published by the U.S. Department of Health and Human Services (AHRQ) in 2007 entitled “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries,” which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding concluded with the following:

    “A history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis [for the child].  For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer…Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.”

    An article posted yesterday on Motherwear’s Breastfeeding Blog originally referenced this study and I highly recommend reading the post as it is both informative and extremely well put!  As far as Rosin’s article, she only cites 2, that’s right…two research articles to support her argument that there isn’t enough evidence that “Breast is Best.”

     

     

    Bogus Claim #3 The segment continues with Rosin stating, “I feel like many people do feel like they’ve failed, if they can’t breastfeed or have trouble breastfeeding, or if they want to stop breastfeeding.  They just feel like ‘I’m giving my kid poison if I give them formula’, and it really isn’t like that.”  In Rosin’s article she also gaffs at the idea of a “lactation consultant” by writing “(note to the childless: yes, this is an actual profession, and it’s thriving).  

     

    What Rosin fails to realize is that lactation consultants are a woman’s ally, not enemy.  Their training and purpose is not to make women feel bad about not being able to or having trouble with breastfeeding, but rather to assist them in anyway so that they can become successful at breastfeeding!  And if after their help a woman still cannot breastfeed (for whatever reason), then at least she can rest assured that gave it her best. Should other mothers now judge this mother?  Of course not!  But that doesn’t mean that the information and support about breastfeeding should not be provided to that mother first!  Rosin alludes to the fact that in this country, women do not have enough postpartum support and yet she degrades one profession that seeks to do just that!  And furthermore I’d like to shout, Hey NBC!!!  How about next time you put together a panel to speak about breastfeeding issues, you include someone who actually is an expert in breastfeeding or breastfeeding education, like a lactation counselor, La Leche League leader, pediatrician, nurse, midwife, or obstetrician, instead of an Otolaryngologist (a head and neck surgeron) who specializes in head and neck cancer.  (That’s right, Dr. Nancy Snyderman is an otolaryngologist).  To me, that’s downright irresponsible journalism. 

     

    Bogus Claim #4  Both Snyderman and Rosin stress the inconveniences of breastfeeding throughout the segment as well as pointing out the societal pressures against it.  “If you want to clear a zone of inhibition around your lunch table [at work], breastfeed your baby in public,” squawks Snyderman. By this point in the show, I began to think to myself, what is this segment’s main argument?  Is it that some mothers know the benefits of breastfeeding, but question whether the benefits are worth it to them?  OR Is it that breastfeeding does not offer health advantages for both mother and baby over formula feeding?  I hate to break it to the Today Show, but the former statement, although very saddening, is probably true…but the later statement is just blatantly FALSE! 

     

    Is it that mothers should support each other, even if situations beyond their control arise that prevent their ability or shorten the length of time they’re able to breastfeed? OR Is it that formula is just as good as breast milk and therefore breastfeeding isn’t worth the “bother and inconvenience?”  Because again the former statement is true…but the later statement is blatantly FALSE!  Sadly, the Today Show automatically promotes both of the later statements with its sensationalized hooks and trailers for the segment, which were repeated before every commercial break for 30 minutes before the piece aired.  Oh, and by the way Snyderman, formula might not be poison, but I certainly don’t think it is conscientious to go on national television and call it “wonderful” and as healthy of an alternative.”

     

     

    Bogus Claim #5  On www.today.msnbc.com, Mike Celizic recaps the segment by writing, “After decades of indoctrination delivered with evangelical fervor, American women have come to take it as an article of faith that if they don’t breast-feed their children, they’ll grow up to be underachievers plagued with health problems and lacking a bond with their mother.”  Oh the drama! (…Give me a break!!)

     

    In reality, if an organization or health care provider details and promotes the benefits of breastfeeding it does NOT mean that they are telling women that not breastfeeding their child will result in harm and danger.  It’s about RISK REDUCTION.  The truth is, research supports the belief that breastfeeding might lower your child’s risk for a variety of illnesses and reduce a mother’s risk for things like postpartum hemorrhage and postpartum depression.  That doesn’t mean that every woman who bottle feeds will get postpartum depression and her baby is guaranteed to be plagued with frequent diarrhea and ear infections.  It just helps decrease their risk!

     

    Furthermore, when I go to the dentist and the dentist looks at my teeth and says to me, “Have you been flossing twice a day?” and I say “No…” and then he goes over the benefits of flossing and the risks of not flossing, what is wrong about that interaction?  True, I might be a bit embarrassed and feel a bit guilty about not flossing, but that doesn’t mean that the dentist should NOT tell me about the benefits of flossing!  It would be irresponsible of him as a health care provider to not at least make sure I knew all the risks and benefits and then if I still decide that flossing isn’t something that’s “worth the time”, then I have the right to make that decision for myself as an adult.  But throughout her article, time and time again, Rosin writes negatively about providing women with counsel and educational information regarding breastfeeding, NOT just about the unfortunate judgment that some women might face from their peers if they make the decision not breastfeed.  When I ask a patient if she is going to breast or bottle feed during my admission interview as a labor & delivery nurse, and she tells me she is going to bottle feed, it is my responsibility as a health care provider to ask her about her reasons and provide her with educational breastfeeding materials so that I know in the end, if she decides breastfeeding is not for her, it is not because of misinformation, old wives tales, misguided pressures from family, or a lack of education, but because it is just her decision.   

     

    Bogus Claim #6 As for the time commitment argument, on the show Rosin stated “…and we all know what a time commitment breastfeeding is… I mean it’s a pretty serious commitment to breastfeed.  It’s not like taking a prenatal vitamin.”  She elaborates on this position in her article by writing, “[Breast-feeding]is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.” 

     

    First I personally know women who work in offices, restaurants, schools, parks, and hospitals, in white collar jobs and blue collar jobs, as doctors, nurses, teachers, farmers, bus drivers, waitresses, and stay-at-home moms, who would like Rosin to know that they believe, as well as myself and many others, that their work IS meaningful.  And if you are a mom who feels differently, who feels “miserable, stressed out, or alienated by nursing, or who feels her marriage is under stress and breast-feeding is making things worse”, then perhaps you are right.  Perhaps you shouldn’t be breastfeeding and perhaps you should also honestly consider obtaining counseling or joining a support group for new mothers because breastfeeding probably isn’t the root of all of your problems.  But for goodness’ sake, for Rosin to go around writing and stating on national television that “the actual health benefits of breast-feeding are surprisingly thin” and that breastfeeding is just “instrument of misery that mostly just keeps women down” [both direct quotes] is untrue, misleading, and hurtful to gestating and new mothers everywhere, both planning and not planning to breastfeed.

     

    Second, I would like Rosin to know that MANY healthy practices in life take a time commitment.  Our primary care physicians and cardiologists often tell us Americans about the health benefits of eating a well balanced diet low in saturated fat as well as the benefits of exercising regularly.  Everything we do in our lives to better our health takes time, but that doesn’t mean that our doctors and other health care providers shouldn’t continue to educate people on these healthy practices just because people might feel “guilty” if they don’t do them!  And it also doesn’t mean that if you don’t exercise three times a week and eat a balanced diet that you are guaranteed to die of a heart attack.  It just helps to reduce your risk!

     

    In conclusion, the state of maternity care and postpartum support in this country is in a crisis, and if we don’t even have the media reporting good research and promoting healthy living for ourselves and our children, it is only going to continue to get worse.  Shame on NBC for being so irresponsible; it’s one thing for The Atlantic to publish an opinion piece (no matter how outrageous), but it is another thing to put this woman and her bogus research on national television and try to pass it off as news.  The unfortunate thing is that for some people, shows like Today are their only source of news!  As a society, we should be focusing our energy towards making things better for new mothers by using the power of the media for good, like airing segments on breastfeeding/new parent support groups and tools for breastfeeding success or helping to pass legislation that makes appropriate break time, a clean & quiet place to pump, and an adequate place to store milk something that is available to ALL working mothers!  But instead the Today show decided to throw their hands up and agree that things are never going to change by providing unchallenged air time to this sorely misled mother.  And if shows like Today continue to propagate and support such astounding untruths on national television, they are going to continue to hurt America. 

     

    Top 10 DOs & DON’Ts of Pooping During Labor & Birth March 15, 2009

    On February 8th, 2009 I wrote a post entitled Top Ten Things Women Say/Do During Labor (And trust me… they are totally normal!).  This piece has been the most popular post on my blog yet, which is pretty exciting!  When I originally thought of the piece, I figured that most women would stumble upon it by searching for something like “Things to do in labor” or “Things women say in labor”.  However, upon reviewing the top searches of February/March for this blog, I was surprised to find that they didn’t include those phrases at all!  Instead they all had one simple thing in common: POOP.  That is right… poop! 

     

    Here are the top 7 searches for NursingBirth in the last two months:  (Note: The wording is not altered at all…these phrases were actually typed into a search box and searched for!):

     

    #1 Pooping in labor

    #2 Will I poop while I push?

    #3 How many women poop during delivery?

    #4 Labor and delivery nurse poop

    #5 L&D nurses and bowel movement during delivery

    #6 Woman in labor thinks she has to poop

    #7 What will happen if I poop during delivery?

     

    Since I am a labor & delivery nurse, I am naturally inclined to jump on any opportunity to talk about bodily functions (especially during awkward times like dinner or outings with the in-laws J) and consequently, I have been inspired to write a post about, what seems to be, the number one thing on every pregnant woman’s mind…POOP!

     

    So here they are:  The Top 10 DOs & DON’Ts of Pooping During Labor & Birth

     

    #1 DON’T forget that life does go on after an embarrassing moment.  How many of you have accidentally passed gas during sex?  You’re all “hot and heavy” with you man (or woman) and you’re both getting into it and then…whoops!  If he/she happened to make a big deal out of it, hopefully you kicked him/her to the curb!  Let’s face it, the people that are closest to us often see us in embarrassing situations at one point or another in our lives: bowing down to the porcelain god after a night of partying, passing gas during lovemaking, runny nosed and hacking up a lung during a bout with the flu, squatting to pee in the woods during an outdoor sporting event etc. etc. etc.  And if those things happened in the company of someone who really loves you, they probably still loved you just as much, or even more, afterwards.  Cuz hey, you’re human!  (By the way, I have personally experienced all of those things so if you are laughing and thinking the same thing…you are not alone!  And for the record, the guy that I passed gas on during sex ended up marrying me this summer so it couldn’t have scared him that much!)

     

    #2 DO understand that the vast majority of women poop during the birth of their babies and that this phenomenon is NORMAL.  If you think about it, when your birth attendant tells you to “bear down and push” they are really telling you to “push like you have to poop!”  It is the exact same motion.  And if you do poop, your nurse, midwife, or doctor is usually reassured that you are pushing correctly!!  In fact, the WORST thing you can do is not push right because you are afraid to poop!  I have seen it happen before and it is such a shame because these women just end up pushing for way longer than they should have all because they let their fear of embarrassment overcome them.  As a labor & delivery nurse, I do not keep records of exactly how many women poop during birth (can you imagine pooping statistics!  haha! J) but you can rest assured that it is the VAST MAJORITY of women.  If someone you know tells you they didn’t poop during childbirth they either are: #1) part of the very small minority of women who actually don’t, or #2) just didn’t realize they did.  And to be honest, #2 is way more likely!

     

    #3 DON’T invite anyone to be present at your birth that you are not totally and completely comfortable with them seeing you in your most vulnerable and trying moments.  Let’s be honest, even in the closest of relationships not many women are comfortable going to the bathroom and pooping in front of their significant other or family members but it is important to understand that the circumstances of childbirth are way different than just your daily morning bowel movement.  My mother doesn’t prefer to be there when my grandmother is bathing, dressing, and going to the bathroom but when my grandmother broke her arm this past winter and needed surgery, that is exactly what my mother did because she needed her.  And I would do the same thing for my mother as I know she would (and has) done for me!  Passing a bowel movement or gas during labor & birth are normal bodily functions that happen during normal labor (as is burping, throwing up, grunting, groaning, crying, etc).  Labor and birth are NOT spectator sports and you are NOT a “hostess” and therefore if you are going to be too preoccupied with the thought of how embarrassing it will be to poop in front of your mother or sister or best friend, then perhaps you should think more carefully about who you invite to your birth.  Just because a family member loves you and “really wants to be there” at your birth, it doesn’t automatically make them a fitting labor companion.  Remember, excessive worry and fear during labor releases hormones that can physically slow or stop your progress!

     

    #4 DO go to the bathroom and empty your bowels (only if you feel the urge) in early labor.  Feeling like you have to “poop” during active labor or transition is almost always the baby putting pressure on your rectum.  Even if you end up passing some stool during the pushing stage, the rectal pressure you were feeling right before was NOT poop, it was the BABY and therefore you would have STILL felt intense rectal pressure even if you had emptied your bowels earlier!  However, if you are in early labor and you feel like you have to poop and you can easily pass stool without straining, then go ahead.  In early labor, it won’t hurt the baby or your cervix.  That being said…

     

    #5 DON’T try to go into the bathroom during active labor or transition and “try” to have a bowel movement right before the pushing stage just because you are afraid of pooping during birth.  If you are in active labor/transition and you feel rectal pressure, please know that it is the BABY pressing on your rectum that is giving you that sensation.  Therefore straining to have a bowel movement during this time could at best, worsen your hemorrhoids and at worst, injure your cervix by causing it to swell or tear.  There is an appropriate time to start pushing, and many women tell me it is the best part (because they can actually do something about all that pressure!) but it is only time to push when your birth attendant gives you the okay. 

     

    #6 DO make a pact with your labor companions (husband, partner, mother, sister, etc.) to NOT tell you that you are or did poop during your baby’s birth if you happen to be really self conscious about it.  The vast majority of the time the mother doesn’t even know that they did poop because the nurse, midwife, or doctor quickly wiped it away.  Trust me, as a nurse, you see it all the time and if vomit, pee, spit, poop, or blood bothered us, we wouldn’t be nurses, midwives, or doctors!

     

    #7 DON’T ask for an enema/accept an enema before or during labor.  Please!  Given enemas to women in labor is an outdated and unnecessary practice.  Birthingnaturally.com writes:

    “A substantial portion of women in labor will have bowel movements, whether or not enemas are given,” especially during both early labor and pushing (Mahan and McKay 1983:247). Available evidence indicates that enemas do not in fact decrease the chances of elimination during birth nor the incidence of fecal contamination during labor, whereas they do often cause considerable pain and distress to the laboring mother (Romney and Gordon 1981; Whitley and Mack 1980). Moreover, the expulsion of feces during labor does not seem to increase infection rates: in a study of 274 birthing women randomly assigned to enema or no enema groups, no difference in infection rates was found (Romney 1981), and the risk of neonatal infection was very remote (seven babies from each group showed signs of infection which may or may not have had to do with bowel organisms). Another finding of this study was that the two groups had similar durations of labor, contradicting the notion that enemas shorten labor.”

    Also as a side note, please don’t take Immodium AD before labor to “prevent” pooping!  It will at best, not work and at worst, make you constipated.

     

    #8 DO remember that your body will probably “cleanse” itself out during “pre-labor”.  After all, mild diarrhea or loose stools can be a sign of “pre” or “early” labor.  And even if you do experience “pre labor diarrhea” you might still poop during delivery and that is okay!

     

    #9 DON’T limit your food intake during labor if you are hungry because you are afraid that you will poop (or throw up for that matter).  A runner does not prepare for a marathon by starving themselves and you shouldn’t prepare for birth by starving yourself either.  Both you and your baby need energy to have the endurance for a successful vaginal birth.  If you aren’t hungry, well then that is different, and you should still be encouraged to drink at least 4 oz of water, juice, or Gatorade every hour.  If you are preparing for a normal vaginal delivery, even if you are being induced, you should not have to follow a “clears only” or “nothing by mouth” diet.  Good prenatal nutrition recommends women eat 6 small meals per day with frequent healthy snacks so why should we starve women during labor?  The answer is: we shouldn’t!!

     

    If after reading all of the above you are still worried about pooping during delivery, then:

     

    #10 DO realize that “WORRY is the WORK of pregnancy!”  In her book Birthing From Within, certified nurse midwife Pam England tells the story about a patient of hers (Hannah) that worried a lot about having a natural birth experience after having had a highly medicalized birth with her first baby.  She writes that Hannah longed to hear her say things like “Don’t worry” and “Everything will be alright” but instead England encouraged her to face her fears.  She instructed Hannah to write down all of her worries and explore each of them with questions like “What, if anything, can you do to prepare for what you are worrying about?” and “If there is nothing you can do to prevent it, how would you like to handle the situation?” 

     

    England lists the “Ten Common Worries” of Pregnancy as:

    1)      Not being able to stand the pain

    2)      Not being able to relax

    3)      Feeling rushed, or fear of taking too long

    4)      My pelvis not big enough

    5)      My cervix won’t open

    6)      Lack of privacy

    7)      Being judged for making noise

    8.)      Being separated from the baby

    9)      Having to fight for my wishes to be respected

    10)  Having intervention and not knowing if it is necessary or what else to do

     

    I would like to add #11:

                11) Fear of pooping in labor/Fear of embarrassment regarding bodily functions

     

    In summary, if you are a pregnant mom reading this post, please know you are not alone in your worries!  Please use these next few months, weeks, or days, preparing not only physically, but mentally and emotionally for the amazing journey you are about to embark upon.  Please understand that getting ready for labor doesn’t just mean a tour of the hospital or learning about birth technology/interventions, but also means acknowledging and talking about your worries and fears with people you trust, especially your birth attendant!  No mother can give birth if she feels unsafe, senses danger, or has never explored her fears, even if they seem “trivial.”  Please know that although the thought of it might be “mortifyingly embarrassing,” when you actually are working hard to push out your baby, anyone that really cares about you and loves you will not be bothered by a little poop and most likely, you will not even notice it!  Please know that although birth might be one of the messiest experiences of your life, no amount of fluids, cursing, farting, vomiting, striping naked, howling, crying, peeing, bleeding, or pooping will take away from how honestly empowering, mind blowing, and touching this experience can be for you and your family J.

     

    Pregnant In America: A (Brief) Review March 13, 2009

    I recently was sent a link to a website that lets you watch the 2008 documentary entitled Pregnant in America: A Nation’s Miscarriage for free.  The catch is that it will only let you watch 72 minutes of the movie, and then it makes you wait an hour to watch the rest (unless you sign up for their program which costs money). So if you don’t mind watching half the movie before dinner and then the other half after dinner, it’s worth it to just wait watch it for free!

     

    The synopsis posted on the documentary’s website reads:

     

    “Pregnant in America is a motivational and inspirational documentary made by film maker Steve Buonagurio about the birth of his daughter Bella. Shocked by the greed of U.S. hospitals, insurance companies and medical organizations, Steve and his wife Mandy set out to create a natural home birth in a world where everything is anything but natural. The film is as much educational as it is entertaining and prepares excepting parent for their uncertain journey of being pregnant and having their baby.”

     

    My overall impression of the movie was good, as it is very empowering to see “ordinary” people (that is, couples who are not already in the birth advocacy community) honestly researching all their options once they become pregnant as opposed to buying into the medicalized culture of fear that so many of us grew up to believe is the only way.  I have been meaning to watch the movie a second time so that I may give it a more thorough review but just haven’t found the time.  Check back soon for an update!

     

    My only criticism of the movie is that it seems a bit scatterbrained and “all over the place” at times and when I finished watching the movie, part of me felt like there was no real cohesive message but instead, a bunch of scattered messages throughout.  Other than that I feel it is a documentary worth watching.  I am also interested in hearing all of your impressions too J!  What do you think?!