Rights for Women's Health- Be an Advocate for You and Your Baby!

It has been 21 months since I have given birth for the first time, and this blog post has been simmering in my head since then. If you are just a little curious and don’t want to read this whole thing, I will sum up:

In general, I find that when it comes to labor and delivery of a baby, many women are resigned to the fact that it is going to be a gut-wrenching, horrific, unbearable, painful experience. That there is a need to fear it, and that if you don't have all the medical interventions offered, you will probably not make it through it at all. Western culture, especially in the media, has perpetuated this view of labor and delivery.

First a little bit of research. It has been found that the biggest predictor of a women's experience with labor pain is her level of confidence in her ability to cope with labor. Having continuous support during labor decreases use of pain meds and increases satisfaction with the birth experience(2). The labor and delivery process is beautiful, spiritual, hard work, and your mindset and that of your doctor/midwife, husband, and family will influence how the experience unfolds. There are many choices to be made that will affect how everything goes down. All I ask is that you make informed decisions and be prepared so that labor and delivery is not a feared and horrible experience.

Here are the main points: 

1.       Please find a health care provider who respects you and your baby, and will take time to answer your questions. Also do some of your own research (from reputable sources named below) in order to make the best decisions for you and your baby. Medical professionals are people too, and may have differing opinions about what is best for you. Make sure it is really what is best for you, and not just for the provider.

2.       There are many medical interventions that are available surrounding the whole birthing process. Somehow, the earth has been populated with women giving birth for a very long time without these interventions. Medical advances are amazing and have blessed many people’s lives. Babies born very early are living and developing relatively normally after stays in the NICU. Mothers who are hemorrhaging are saved. Babies that may have died without a C-section are healthy! These are all situations that are emergencies. The labor and delivery process itself is not an emergency, and all the medical interventions can really mess it up for those with a normal, healthy pregnancy. For those with high risk pregnancies or are pregnant with multiples, hooray with OB-GYNs and medical interventions! Thank you for saving so many babies’ lives!

3.       There is a ton of high quality medical studies out there about pregnancy and childbirth. It is hard to have access to each study and to stay on top of the latest evidence. I found this website to be extremely helpful. It is written by a nurse with a PHD and peer reviewed by several doctors and other professionals. It is very well done and is fairly unbiased, just stating what is being found in the literature. Evidencebasedbirth.com. If you have questions about anything you read there, ask your OB or midwife. If they don’t agree with the evidence, bring them the study to read. And if they are still fighting you about what you want to do, find a new doctor. Doctors are people too and make mistakes. You have the right to make the final decisions about your health care.

4.       It is not ok to be guilty about what has happened in the past in regards to birth experiences. Every birth experience is unique and precious. Many of the ladies in my hypnobirthing class were there to become informed and have the best birth experience possible after having some not so great ones. Some were going for a VBAC (vaginal birth after caesarean). All you can do is try to be informed and make the best decisions for you now and from now on. I am not looking to put more guilt or shame on anyone.

A little background: In my final semester of physical therapy school, we took a men’s and women’s health class. Almost the whole section on women’s health dealt with problems that happen to women due to trauma during childbirth. Urinary and bowel incontinence (peeing and pooping yourself), pain, etc. All of these things sounded horrible to me. I also got pregnant during this semester, and determined that I would arm myself with knowledge to help me have the best birth possible and hopefully not suffer any of the horrible consequences.

     My mother had 5 children, 4 naturally the hard way, and the last one utilizing hypnobirthing. She said it was so different of an experience that I definitely had to try it! At 20 weeks gestation, I began a hypnobirthing course. I learned about all the decisions associated with the labor and delivery process that will be made for you if you aren’t informed and make the decision beforehand. I learned deep relaxation techniques to help me relax and decrease my fear and apprehension about giving birth. Breathing techniques for different parts of labor were taught and practiced. My husband learned how to support me during labor. The class only lasted 5 or 6 weeks, but after that, we practiced!

Every night from 30 weeks on, I either listened to a relaxation script or had Austin do one for me. I practiced my breathing and letting myself relax. I stayed in shape by walking, swimming, and doing some light strengthening, including some abdominal work. We moved across the country during my pregnancy. I had to find new midwives that were supportive of natural birth and hypnobirthing. We wrote a birth plan. I continued to practice.

The wonderful ladies at my church threw me a baby shower, even though I had just moved in a few months earlier. It was a lot of fun, but you know how baby showers sometimes go- especially for new mothers. Lots of birth advice. “Just get the epidural” I heard a few times. When I explained about my hypnobirthing classes and hope for a completely natural water birth, the reception was more like, “well, let me know how that turns out for you!” Even though there were skeptics, I knew I had prepared and that I could do it.

 I wanted desperately to go into labor naturally. When I was 10 days overdue, the midwives had to schedule an induction. I started having fairly regular contractions and went to the hospital. They were not regular enough, and I was only dilated to a 2. My midwives gave me an option- I could be induced that night (vs. the following night) and forgo the natural birthing suite and water birth that I had planned on, or I could go home and try to get things moving along more and come back later. She confessed after Landon was born that both midwives that took care of me thought I would be back later that night. I wasn’t! The next morning, I had given up. Landon was never going to come out. Then my contractions started getting really regular. Around lunchtime, I went so far into deep relaxation that I stopped timing contractions. Austin went to have lunch and talk to his family. I was upstairs bouncing on a therapy ball at home. My mom found me and timed some contractions. They were a minute apart. By the time I got to the hospital, I was an 8-9 and minutes after getting into the birthing tub I started pushing and Landon came out not too long after. I did it all naturally and mostly at home- eating food and drinking whenever I wanted to. It was pretty much exactly what I wanted.

After giving birth, I appreciated what a church friend had talked to me about when I was first pregnant. She had two kids, and told me that going through labor is like running a marathon- an intense physical experience. If you are not prepared, it will hurt a lot and probably not turn out how to want it to. The key is mental and physical preparation. If you are prepared, you shall not fear! In PT school we learned about how the mind can be very powerful, and how part of treatment for fibromyalgia (a chronic pain disorder) could be guided relaxation. When you are experiencing fear, your muscles are tight and this alone can cause pain. Add to that a fear of pain itself and this intense physical experience, and you have a perfect storm. I could not have done a natural birth without the coping techniques taught in hypnobirthing.

Now I am going to run down some of the most common medical interventions and why I think they are a bad idea in the case of a healthy woman and normal pregnancy.

Induction: Guess what? Most babies will come out eventually! If calculated from the day of your last missed period, your due date could be up to two weeks off. Babies give off hormones when they are done baking in your belly. If your body is also ready to give birth, it gives off hormones and labor starts. Both pieces need to be ready for labor to begin. It saddens me when people are induced and then their babies end up having some early health problems because they were forced out. There are some really good medical reasons to be induced. For the convenience of being able to schedule a time to show up at the hospital is not one of those reasons. Because you can't wait to meet your baby, or because you are sick and tired of being pregnant are also NOT good reasons. Every mom wants a healthy baby. Let your baby cook for as long as they want. I had Landon 11 days late in the middle of a horribly hot summer. If I can wait to meet my little guy, so can you.

I haven’t even mentioned the induction drug, Pitocin. I had the wonderful experience of getting some Pitocin after giving birth because I was bleeding too much. It was horrible. It made me feel sick to my stomach, and shake all over the whole time it was being administered. I can’t even imagine trying to get a baby out of my tummy under these conditions. Why subject yourself to that? Also the unnaturally strong contractions and decreased space between contractions just makes it hurt so much worse it is much harder to have a natural birth.   

Epidural: The medical consensus is that epidurals slow down labor significantly putting you and your baby at risk. It may cause a “failure to progress” in labor, which is a farce anyway according to http://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/.  The worst position to labor is lying flat on your back, which is one of only a few positions available to those who elect for epidurals. Lying flat on your back is conveniently the best position from which your OB can catch your baby without having to do something uncomfortable like bend over or squat near the ground. I labored at home on a birthing ball, lying on my side, walking around, whatever felt best. Your body knows how to expel babies. If you listen to your body and position yourself in the ways that feel best, that is ideal. Putting yourself in a position where you cannot listen to your body because you can't feel it is not ideal for you and for the health of your baby.

 However, many that I have talked to say that their epidurals did not work properly. So awkwardly, only half of their lower body was numb, and they could feel half the pain. If an epidural is your coping strategy for labor, what are you going to do when your epidural is not effective? There are risks with getting an epidural. Epidurals are associated with a decreased probability of spontaneous vaginal delivery, a higher rate of instrument assisted vaginal delivery, a higher rate of fever in mom during labor, longer 2nd stage of labor- especially first-time moms, low blood pressure during labor- decreasing nutrient and oxygen flow to baby!, and higher rate of babies being born with sepsis (serious infection in the blood). (1) Epidurals increase the risk of serious perineal tearing, negatively affects newborn behavior vs. unmedicated infants, and increases the likelihood of jaundice. (2)

Do you STILL want to just ask for the epidural right away!?! Personally, I do not want a huge needle going anywhere near my spine or my spinal nerves, thank you very much. I would like to keep my cerebral spinal fluid inside of my body when I am trying to get a baby to come out of me. I also would like to keep the money in my pocket that would go to the anesthesiologist who would probably mess up the epidural anyway.

C-sections: The C-section rate in this country is UNREAL. 30% of first-time mothers have C-sections. WHY?!? Partially it is due to the problem noted above in the link. Friedman’s curve is a chart of how labor is supposed to go based on women who were drugged going through labor in the 1950s. OBs use this curve to decide if you are not progressing through labor at a normal level. If I had had an OB for my labor and delivery, I would have been on Pitocin right away and probably also had a C-section because my body was just taking its time to prepare for my baby to have a relatively peaceful journey out.

One of the presenters in my physical therapy women’s health class said that OB-GYNs get into this specialty because they are interested in surgery. They get paid more for doing surgery. Why wouldn’t they just send you to the OR? You get your baby faster, and with less effort, (albeit horrid healing times) and they get to go home for dinner! I know that there are many wonderful OB-GYNs in the world who would never do this, but for every one of those, there has to be a few that prescribe to this strategy. A few things we learned in class if you are selecting to go with an OB vs. midwife is find out their C-section rate and the C-section rate at the hospital. If it is abnormally high, steer clear and find someone who is not going to cut you open for convenience. For those who have had a C-section before, some doctors will go straight to doing C-sections on you from there on out. There may be medical reasons for this, but VBACs are being done more and more, and it is all about choosing a provider who will support you in this decision. Scheduled c-sections are on my list of major pet peeves. If your body is not in labor yet, your baby is not done growing inside of you. It would be like picking an almost-red tomato. Not quite ripe and not ready yet.

Stripping your membranes/bag of waters: If your water hasn’t broken yet, that is a good thing. That means that your baby is safe inside of you and no bacteria can get in. There is no significant evidence that this speeds up labor. What it does do is forces you to stay at the hospital (in most cases) and sign up for a laundry list of other medical interventions that you really don’t need to speed up the labor your body and your baby were not ready to have. My water didn’t break until my 3^rd or 4^th push, immediately prior to Landon’s head emerging. Your water breaking is not something that needs to happen prior to labor starting. What does happen when your water breaks is your baby’s cushiony soft ride becomes a lot harder and more hostile of an environment.

Ok everyone, here is the deal. Don’t just go to the same provider as your mom or your sister just because. Don’t go into labor completely unprepared to cope with it. Do your research. Practice whatever techniques you want to use during birthing. Treat this like the intense physical test that it is, instead of something you’ll just “suffer through” to get the amazing little new creation at the end because that’s the way your mom did it. Break the mold and get informed.  

Rant over. 

Sources:
1. Lieberman E, O'Donoghue C. Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetrics and Gynecology. 186:5, 2002, S31-S68.
2. https://www.childbirthconnection.org/article.asp?ck=10183
3. Evidencebasedbirth.com/topics/ is the place to go to see all of the articles they have to offer!