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Tuesday, March 13, 2007I was thinking this week about my post on the lack of good information for moms that end up exclusively pumping. My biggest frustration with that wasn't just that there was a lack of information but that there seemed to be a lack of information because no one CARED about helping those moms. I could never help but shake the feeling that many people were secretly thinking "well it's nice that you're giving your kid breast milk, but you should have tried harder to make nursing work."
Now I'm well aware that that's MY issue...I'm sure it was the minority that thought that way, but I'm interested in how I see that type of attitude carry over to childbirth issues as well.
I host the Childbirth Choices Debate board over at BabyCenter and I do a lot of reading on natural childbirth, home birth and so on. While I don't know that it's intention, I see a lot of "all or nothing" attitude in that realm as well and it disappoints me.
Here's what I mean by that...
When I see a post by a mom talking about their first birth experience and how disappointing it was or I read a post from a mother that's pregnant and is running into problems with her caregiver, I'm often astounded at the response. Generally, the response boils down to "you should have a home birth, that will solve all of your problems" or "you need a midwife, that will solve all of your problems" or "plan for an unmedicated birth, that will solve all of your problems."
If a mom jumps on any of those three ideas, advice and support literally rains down on them as people share detailed information about how to get the birth they want, what studies support low-intervention birth, where to find a low-cost or even free doula and so on.
This is fantastic! I'm one of the first to ask people if they've ever considered using a midwife or having a baby at home. After all, that's how I "solved" the issues of my first birth when I wanted to make sure that they didn't happen a second time.
However, I also realize that home birth and even unmedicated birth isn't for everyone. Believe it or not, there are moms (and good ones too) that educate themselves on the risks and decide that they would like to have pain relief or that they would like their baby to be born in a hospital. No, they aren't crazy or deluded, they're just exercising their own choices. Homebirthers (myself included) spend a lot of time explaining that mom will progress much more easily in an environment where she feels comfortable. Well, guess what? Some women feel more comfortable having a baby in the hospital than they do at home. Yes, even when they know that home is just as safe.
The issue here is that once we find out a mom is planning a hospital birth and (gasp!) is using an OB instead of a midwife and (bigger gasp) might want to have the option of medical pain relief, we tend to just say "good luck" and leave it at that.
There's very little info from the educated childbirth community about how to have the BEST medicated birth possible. In other words, many childbirth advocates sort of act like if you plan to have a medicated birth, you kind of deserve whatever you get.
This bothers me. The same way that the subtle attitude against exclusively pumping from some breastfeeding moms bothered me.
So, I'd like that address that in this thread. I'd like to share some tips and suggestions for "medical mamas" on how to have the best birth possible and I hope that my readers would kick in their own suggestions. Let's go against the flow and realize that moms that choose to have pain relief during their labors also deserve to know how to avoid the problems that can come with that cascade of interventions.
My tips to medical mamas...
1.) Make sure that your health care provider is on the same page as you. Just because you plan on having an epidural doesn't mean that you want the whole intervention combo platter. Educate yourself about the various interventions and talk honestly with your doctor to find out when they use them and why they use them. Don't be afraid to switch providers to find someone that shares your philosophies of birth.
2.) Check out your hospital before the birth. Find out what their intervention rates are, what their c-section rates are, what their pre-birth and post-partum policies are. Is there an IBCLC on staff? How quickly can you have access to her? Basically, know what you're getting into and if you have a choice between hospitals, pick the one that best shares your philosophies of birth.
3.) If you plan on having medical pain relief, opt for the epidural instead of IV narcotics. While IV narcotics have the benefit of allowing you to be more mobile in labor, they carry greater risks for both you and your baby. If you do choose to have IV narcotics, find out which ones your doctor prefers to use and do your research on the possible side effects to you and the baby.
4.) Consider signing up for a natural childbirth class so that you can learn coping techniques. Even if you plan on having an epidural, the longer you can delay it, the less chance that you'll have the cascade of interventions and the less chance of harm coming to you or your baby. You may even find that the coping techniques work well enough that you don't want pain relief. Also, realize that 25% of epidurals do not give full pain relief...having some backup techniques can make that situation much more bearable.
5.) Refuse an IV until shortly before you get your epidural. Some women will labor for hours before they feel the need to have pain relief. While you do need to have your IV long enough to get some fluids before getting your epidural, you do NOT need to have it in for your entire early labor. In fact, having the IV in place can inhibit your mobility plus the longer it's in, the more fluids that will flood into your system. An overload of IV fluids can cause blood sugar issues for both you and your baby and can also cause edema which can significantly impact your breastfeeding abilities in the early days.
6.) Avoid induction unless there is a medical reason for it. Inductions carry increased risks to both mother and baby and mothers need to be aware of when the risk of baby staying in is greater than of being induced. Suspected big baby, being between 40 and 42 weeks and your doctor going on vacation are NOT medical reasons for induction. ;) If you do get induced, ask for a "long" induction using cervical ripening agents and then the absolute lowest doses of pitocin. Avoid Cytotec inductions like the plague.
7.) Try to push in an upright or side-lying position. Even if you have an epidural, most women can be assisted into upright positions that take the pressure off of their tail bone and that keep them from pushing against gravity. Pushing on your back with your knees shoved into your chest not only closes the pelvic outlet by 30%, it also greatly increases your risk of having a bad tear.
8.) Avoid an episiotomy unless baby is in distress. Episiotomies are not only unnecessary in 99.9% of moms, they also greatly increase your risk of having a third or fourth degree tear. Read up on episiotimies and make sure that your health care provider is on the same page as you and rarely does them.
9.) Get a doula. There's a common misconception that doulas are only for moms that plan to have a natural birth. While it's true that most doulas really enjoy helping a mom achieve the goal of NCB, most doula have the primary concern of helping mom have a good birth. Be honest with your doula upfront about your desire to have medical pain relief and find one that you can work with that has experience supporting medicated mothers. (As a mom that had an epidural with my first after a failed NCB attempt, I can attest that a doula would have been VERY handy.)
There are more, but that's all I've got off the top of my head. I'd also love to hear any advice from c-section moms on how to have the best c-section experience possible. Not everyone can or wants to have a natural birth at home, that doesn't mean that they don't deserve to have the best shot at a good birth.
What advice do you have to add?
Labels: Childbirth Issues