Our Bodies, Ourselves (85 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
While preparing is important, labor itself is unpredictable. You can't know in advance what you will experience or what you will want or need. Your labor may be easier or more complicated than you imagine. You might plan to give birth without medication and then find yourself needing greater relief, or you might plan on having an epidural but then find you don't need one.
I was determined to have a total “medical buffet” during my delivery. I'd start with Nubain and then move to an epidural and be blissfully pain free. However, when I arrived at the hospital, my OB told me that it was too late for any medical intervention and it was time to push. In fact, I had been lucky not to have had him in the car on the way. I had to throw my “imagined delivery” out of the window and have this baby. I labored for sixty-four minutes in the hospital, and he was born. I was swearing like a sailor and yelled at everyone within a two-foot radius, including my husband. (I swore at my OB so atrociously that when I returned to the same hospital three years later for baby number two, the nurses remembered me.) At one point my OB nonchalantly said, “If you focused that energy on pushing instead of yelling at us, you'd have a baby by now.” I got all huffed up at her and my husband, and then my son crowned. She smiled and said, “I told you.” It was the most powerful moment of my life; I delivered him, cut the cord, and held him in my arms . . . all before breakfast
.
Because it is often challenging to make specific decisions about pain relief before labor, and because all pain-relieving medications can have adverse effects, it is generally best to approach normal labor with the idea of using no-risk or very-low-risk strategies first and then proceeding to the next higher level of intervention if needed. It's also helpful to rest as much as possible during early labor and conserve your energy, as exhaustion can diminish your capacity to tolerate pain and thus increase the need for pain medication. The “Pain Medications
Preference Scale”
can help you clarify
your feelings about pain and pain management during labor.
Your choice of birth setting and provider can affect your options for pain management; for more information, see
“Choosing a Provider,”
and
“Birth Places.”
For more information on specific coping strategies and pain relief methods, see “
Coping with Pain
.”
Learning about our options for coping with labor and working with a knowledgeable support team can help us feel less anxious as we anticipate labor and birth. We can arrive at informed decisions about the approaches we prefer, recognizing that we may need to make changes based on how our labor unfolds.
I was scared of the pain. I wanted to avoid interventions if possible, but I also wanted my limits to be respected. I wanted to see a midwife because I believed that her philosophy of birth, practical techniques, and continuous support would help me have the kind of birth I wanted. But I needed to know that if my labor was really hard or lasting forever, or if I was totally exhausted, she would support me in getting an epidural
.
The first midwife I interviewed when I was pregnant didn't seem to hear my fears; she just said that women's bodies were designed to give birth and that my body would do so also. The second midwife, the one I chose, was more reassuring: she said she knew lots of nondrug techniques to help me cope and manage with the pain but that she was committed to helping me have a good birth, whatever that meant to me. She said that there were times when epidurals were extremely helpful. In the end, I didn't have an epidural, but knowing that it was an optionâand knowing that my midwife wouldn't see me as a failure if I had oneâmay have been part of what helped me avoid one!
Breast milk is the best food for babies; it provides all the nutrients your baby needs to grow, as well as antibodies that protect against infection. Nursing also provides numerous health benefits to you. Whether you are undecided about breastfeeding or committed to it, take time to talk with midwives, childbirth educators, and other mothers and to read available books during your pregnancy. Having good support and plans in place before you give birth can help smooth the way. (To read more about breastfeeding, including how to get off to a good start, see
“Breastfeeding Your Baby.”
)
The transition to motherhood can be challenging, both physically and emotionally. Learning as much as you can and listening to other women's stories will give you information and inspiration to face the challenges of pregnancy and childbirth with greater confidence.
A woman planning a home birth said:
My mother gave birth to me at home. Her mother had given birth to five children and had considered her labors her finest, strongest moments. I know I can give birth and it is hard work, but I trust my body. At night I sit still, close my eyes, breathe deeply, and picture myself opening up. . . . My birth will be unique
.
PAIN MEDICATIONS PREFERENCE SCALE | ||
This table, created by the childbirth educator Penny Simkin, can help you clarify your feelings about pain and pain management during labor. | ||
NUMBER | WHAT IT MEANS | YOUR PARTNER, DOULA, NURSE, OR CAREGIVER CAN HELP YOU BY |
+10 | I want to be numb, to get anesthesia before labor begins. (An impossible extreme.) | ⢠Explaining that you will have some pain even with anesthesia. ⢠Discussing your wishes and fears with you. ⢠Promising to help you get medication as soon as possible in labor |
+9 | I have a great fear of labor pain and I believe I cannot cope. I have to depend on the staff to take away my pain. | ⢠Doing the same as for +10 above. ⢠Teaching you some simple comfort techniques for early labor. ⢠Reassuring you that someone will always be there to help you. |
+7 | I want anesthesia as soon in labor as the doctor will allow or before labor becomes painful. | ⢠Doing the same as for +9 above. ⢠Making sure the staff knows that you want early anesthesia. ⢠Making sure you know the procedures and the potential risks. |
+5 | I want epidural anesthesia in active labor (4â5 cm). I am willing to try to cope until then, perhaps with narcotic medications. | ⢠Encouraging you in your breathing and relaxation. ⢠Knowing and using other comfort measures. ⢠Suggesting medication when you are in active labor. |
+3 | I want to use some medication but as little as possible. I plan to use self-help comfort measures for part of labor. | ⢠Doing the same as for +5 above. ⢠Committing herself or himself to helping you reduce medication use. ⢠Helping you get medications when you decide you want them. ⢠Suggesting half doses of narcotics or a “light and late” epidural. |
0 | I have no opinion or preference. I will wait and see. (A rare attitude among pregnant women.) | ⢠Helping you become informed about labor pain, comfort measures, and medications. ⢠Following your wishes during labor. |
â3 | I would like to avoid pain medications if I can, but if coping becomes difficult, I'd feel like a “martyr” if I did not get them. | ⢠Emphasizing coping techniques. ⢠Not suggesting that you take pain medication. ⢠Not trying to talk you out of pain medications if you request them. |
â5 | I have a strong desire to avoid pain medications, mainly to avoid the side effects on me, my labor, or my baby. I will accept medications for a difficult or long labor. | ⢠Preparing for a very active support role. ⢠Practicing comfort measures with you in class and at home. ⢠Not suggesting medications. If you ask, suggesting different comfort measures and more intense emotional support first. ⢠Helping you accept pain medications if you become exhausted or cannot benefit from support techniques and comfort measures. |
â7 | I have a very strong desire for a natural birth, for personal gratification along with the benefits to my baby and my labor. I will be disappointed if I use medication. | ⢠Doing the same as for â5 above. ⢠Encouraging you to enlist the support of your caregiver. ⢠Requesting a supportive nurse who can help with natural birth. ⢠Planning and rehearsing ways to get through painful or discouraging periods in labor. ⢠Prearranging a plan (e.g., a “last resort” code word) for letting her or him know if you have had enough and want medication. |
â9 | I want medication to be denied by my support team and the staff, even if I beg for it. | ⢠Exploring the reasons for your feelings. ⢠Helping you see that they cannot deny you medication. ⢠Promising to help all they can but leaving the final decision to you. |
â10 | I want no medication, even for a cesarean delivery. (An impossible extreme.) | ⢠Doing the same as for â9 above. ⢠Helping you gain a realistic understanding of risks and benefits of pain medications. |
* |
Labor and Birth
W
omen's experiences with labor and birth vary widely from woman to woman, from one phase of labor to another, and from one labor to the next. Your labor will be unique, influenced by many factors: the size, position, and health of your baby; your health and medical history; your expectations and feelings; the people who support and attend to you; and the place in which you labor and give birth.
But despite the variations, there is a common theme: the natural flow of labor. This process involves interplay between you and your baby. During your pregnancy, your body has held and protected your baby. Now, under the influence of hormones that you and your baby release, your body will soften, open, and yield to allow the baby to pass through. Labor contrac
tions,
your body movements, and your pushing efforts will guide the baby down while the baby flexes, stretches, and rotates to navigate the birth canal. The birth process progresses from the softening (ripening) and opening (dilation) of your cervix to your baby's descent and birth to the delivery of the placenta.
ABOUT THIS CHAPTER
This chapter emphasizes normal physiological labor and the care choices and birth setting practices that help women have safe and satisfying birth experiences. Unfortunately, far too few women in the United States experience optimal births. A survey of women who gave birth in U.S. hospitals in 2005 found, for example, that most women had unnecessary medical and surgical interventions, did not walk or move around in active labor, and gave birth on their backs; and nearly half of babies spent the first hour after birth with hospital staff, usually for routine care.
1
For women with chronic medical conditions, pregnancy complications, or a particularly complicated labor, medical interventions can be lifesaving. However, many medical interventions routinely used during labor and birth are unnecessary and may cause harm. For more information, see “Maternity Care in Today's
Health Care System,”
and “U.S. Maternity Care:
Roadblocks to Change”.
We need to work to reduce unnecessary, routine interference with physiological birth while recognizing that some women and babies need such interventions to experience birth safely. Women with high-risk or complicated pregnancies must be able to access effective treatments without forfeiting the emotional support, physical comfort, and respect for informed choices all women deserve.
Giving birth was life-changing for me and for many of the women I have attended as a midwife. In a world in which we may often feel ineffective and pessimistic, working through labor under our own power can transform our sense of self. We experience ourselves as strong, sturdy, resilient, and able. We tap on inner strengths we may never have tapped before and are amazed by what we are able to accomplish. Once we become aware of how powerful we can be in giving birth, we can call on this throughout our lives, in all sorts of situations
.
A woman who gave birth in a hospital birthing center says:
The day before she was born, I'd done everything: cooked, mopped, even put up a new mailbox in the bitter cold weather outside. At three a.m. my waters broke. We didn't sleep much after that. We had an already scheduled appointment with Lucy at ten. Since I was only 1 centimeter dilated, she said, “Go on home.” . . . Off we went, and all of a sudden, there I was in hard labor, doubled over. Back we drove to the hospital birth center. No one was expecting us; the place was empty
.