What You Shouldn't Have to Expect When You're Expecting 1: Pit to Distress

chemical structure of oxytocin with labeled amino acids (Photo credit: Wikipedia)

So you're expecting a baby and for whatever reason your care provider has chosen to give you pitocin/synthetic oxytocin to start or speed up labor.

Facts:
This medication goes through an IV so it can be carefully controlled. The goal is to have 3 moderately strong contractions during a 10 minute period of time. More than 5 contractions in 10 minutes or less than 1 minute of complete uterine relaxation between contractions constitutes a serious adverse reaction and should automatically result in pitocin being stopped. It may be okay to have it restarted at a lower dose if patient and care provider agree to do so.

Now for the very disturbing reality check:
Pit to Distress

An overstimulated uterus is very common with pitocin yet extremely uncommon with natural labor primarily because the body produces natural oxytocin in short bursts and synthetic oxytocin is run through a continuous IV. Just like any other medication, people react differently. Many people (my hand waving furiously) will experience contractions without relaxation and/or contractions that are way too hard and way too fast.

To be absolutely sure the uterus experiences the much needed relaxation phase during labor, simply place a hand on the abdomen and if it remains hard instead of going completely soft after contracting it is an abnormal and very dangerous situation. Equally concerning is if there are more 5 contractions in 10 minutes and/or less than 1 minute between contractions. If this situation goes unchecked, not only will mother be in distress from unimaginable pain not associated with normal childbirth, but the unborn child will be robbed of oxygen and can become quickly distressed. Continuous monitoring may not give an accurate picture of the contraction pattern and might even miss warnings of fetal distress.

Where is the doctor? Probably not even at the hospital. Doctors and even some nurse midwives are only trained in treating the birth of a child as a medical condition, not in how to wait for nature to do its job.
What about the nurses? Don't they have orders to stop the medication in case of adverse reaction? Not necessarily. They have likely not been trained in what to expect in normal childbirth. If they do know this is abnormal, they may still be ordered to continue the pitocin.

It is up to you to demand evidence based care prior to being given any medication, and if things go wrong be prepared to demand that the medication be discontinued if you react abnormally.


Need resources to make an informed decision?
Evidence Based Birth articles for induction and augmentation

Related articles

• Risks of induction of labor

Braless Confessons

Barbie Basics (Photo credit: dog.happy.art)

Yes, I did run errands this morning. No, I am not wearing a bra.

One of my earliest memories was of playing dress up with my older sister. She padded her new bra for me and everything and I paraded out of the bedroom. I remember my father's deep voice yelling my sister's full name (middle and all!) "Get your bra off your sister!" People sure get ruffled over who's wearing the "right" underwear.

I've never found bras natural or comfortable. Many people say that any discomfort in a bra just means you are wearing the wrong size, which is most likely true, but only part of the story. Bras may actually be unhealthy (Bra Free!)  .

 Maybe you can't say that bras cause breast cancer (I personally believe it's more complex than that), but there may be enough research to say that they reduce lymphatic flow through the breast tissue, which cannot be good.

Some say that it's impractical for all but the smallest breasts. I think not. I've been through most of the usual spectrum of bra sizes, from the pre-kids A cup to a D cup when breastfeeding my youngest child. My normal settled size is not extremely perky. Because I'm smaller my chest looks bigger than average. 

Yes, without a bra they move around more, and I have less cleavage. I don't have an issue with nipples showing, but I do wear a camisole or tank top. You don't necessarily have to throw all your bras away. Sometimes, you may want the illusion they create. Just don't wear them all day, every day. Go for a weekend day or go out to a movie without one (and notice how nobody notices). Work up to grocery shopping and other public bralessness.

Will bras go the way of the daily corset tied so tight that broken ribs were a real possibility? I don't know, but I hope so!

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• The Beauty Of The Braless Woman

Why I don't tell hospital birthers to "go in pushing"

IMGP1260 (Photo credit: Nico Nelson)

Yes, you should try to labor at home as long as possible before going to the hospital. But before trying to use that as your technique to have an intervention free birth (especially for those facing opposition to a VBAC), you need to recognize the inherent variability of the birth process and how hospitals may respond to it.

Good luck calculating exactly when you will be ready to push your baby into the world. If you can do that, be sure to account for traffic, unless you would rather enjoy the first stage of labor in the hospital parking lot. For a fair share of women, the second stage of labor, where they are actually pushing, doesn't last as long as a drive to the hospital. Yes, a fair number of women do get to the hospital just as they are ready to push, but it's not fair to count yourself among them except in hindsight.

Going to the hospital early in labor is just part of our natural instinct to get settled and feel safe before labor is too advanced to move. It's natural to want support and reassurance that the baby is doing well. The problem is when the hospital isn't willing to just let you wait it out. Unfortunately it doesn't matter when you arrive, you can be subject to unwanted and unnecessary intervention without informed consent, up to and including surgery.

The better option is to plan for the birth you want as early in your pregnancy as possible (or even before), and if you meet with hostility change care providers and/or birth location. Keep trying to find what you want and it's never too late to change your mind. You do not need full blown arguments during any part of your labor. In that situation, the person who's not in labor has the upper hand. No matter how it turns out, having to do battle while trying to birth a baby will color the experience. Yes, women who are actively and successfully pushing out a healthy baby can still get wheeled into the operating room against their wishes.

What not to say to a traumatized mom

Dear friend/family member,

If you're reading this, it means you are an amazing human being who cares. You want the special mom in your life to feel better. It's painful for you to see her reliving her trauma, and like her you just wish it would stop. You've either tried to say something comforting, not known what to say, or both. I wish I could tell you the magic words, but there aren't any. However, I can tell you the two things not to say.

1. "At least you had a healthy baby."

It is wonderful to see your children grow despite a traumatic birth experience or whatever else happened along the way. I wish that was enough to keep all moms from doubting themselves. All moms who had traumatic births wonder at some point if something they did could cause even minor issues. For me, it was first when I had to fill out papers for speech therapy for my younger children and it actually asked if there were birth complications including labor over 24 hours. It comes into mind at nearly every stressed out mom moment.

A mom who was traumatized often wonders if her birth experience irreparably damaged the parent/child relationship. She almost certainly struggled to survive her child's first few weeks/months. Maybe her child did come out unscathed, but she didn't. She is dealing with mental and often physical scars as well.

Is it entirely unreasonable for her to expect to have been treated better during such a life-altering event? A healthy baby isn't all that matters. If there was not evidence based care, she was put at needless risk of complications, including death. Childbirth should not be like a war zone with mom practically needing a real gun to enforce her right to say what others can and cannot do to her body. It's way too common for moms to experience symptoms like those who have experienced war and gunfire because birth is treated like a battle and the mother is a lowly soldier expected to take orders (even if those orders violate her instincts or deeply held personal beliefs). In truth, birth is a natural process meant to leave the mother physically and mentally strong enough to care for her child and possibly have more in the future.   

Birth is a deeply emotional and even spiritual experience, not just a physical event. When well meaning people remind the traumatized mom to notice her healthy child, all she hears is "Your experience doesn't matter." Acknowledge that her experience obviously matters if it's still affecting her.

Traumatized moms are already very angry at themselves for not being able to deal with it alone. Talking to you about their trauma isn't any easier for them than it is for you. They aren't trying to dump on you nor are they asking you to solve anything. It is a process that they're trying to find their way through. Lack of support contributed to their trauma so every time someone isn't supportive they relive the trauma of going through something as difficult and life changing as childbirth thinking nobody cares. Even if you can't listen at that moment, remind them that you do care.


2. "Some women have more tolerance for pain." (or any other variation of the idea that some women just can't give birth in whatever way allows them to feel good about themselves)

Short of laughing and saying "I knew you couldn't handle it." (Yes, someone actually did that to me after the birth of my first child.) there is nothing worse to say to a traumatized mom. What you're probably trying to say is that everyone is different and we shouldn't all be held to the same standard, but what the traumatized mom hears is "You're a failure at birthing your children. Your mind/body aren't as good as those moms who had a drug-free birth."

It is very true that experiences vary widely. Some women experience a short labor with little pain while others have a long labor with a lot of pain. It's not a crime to prefer medication during childbirth, nor is it a crime to want no interference in a completely natural birth. Many women experience trauma when they expected medical pain relief and didn't get it or it didn't work. Other women wanted to experience natural childbirth but received medications that they feel they should have done without. It's the experience of feeling that a choice was made without you, or the even worse feeling that you had made a firm choice and it wasn't respected or supported.

The issues surrounding birth trauma are complex. For many, it was a preventable c-section or vacuum extraction. For others, it was being stuck in bed and strapped to a monitor and IV line. For me, it was having my natural labor contractions be deemed not good enough and having my body chemically forced to work harder (it felt more like a violent poisoning than birthing a baby) without me being given the option to just wait it out.

Moms need to feel a sense of joy and pride after the birth of a child so that they can give their best to their family and to society. When a mom feels so beaten down by the experience that she wonders if she will ever get up, the whole world is just a little more broken. No one person can fix it, but a single kindness can put one person in the right direction for a moment. That's all that's needed. Other moments may come when that one needs you again, but if you just take this moment and find a way to let it pass without judgement or anger (and not reminding her that she really should just pull herself together because she already knows that and will do it as soon as possible).

 A traumatized mom has this unshakable thought that birth is a right of passage/test and she failed/flunked. Rationally, we all know it's not a contest. Rationally, we all know that our lives must go on after the birth of a child, and no matter how difficult the birth was it's over and we never have to go through that experience again (if we have another child it can be handled differently). Still, there is the shaky sensation, maybe within the very nerve fibers connecting our minds and bodies, that something is very very wrong. Somebody stole something, but it can't be seen so no one can see how valuable it is. We can't find it and take it back, except when we can. When our true stories are acknowledged and retold, we are taking that very special sacred story about how much kinder and gentler birth can be and giving it to the future. Maybe you feel like you aren't doing anything but hearing her angry words and watching the tears fall from her eyes, but really you are making the experience of birth more humane, not just for her, but for all humankind.

VBAC is a human right!

Excuse my language but the sh** happening to moms searching for birth options after they have had a c-section is an amazing landslide. Providers say everything from "we'll see" to flat out "no way." Hospitals have flat out bans that lead to moms being wheeled into surgery against their will. Even more disturbing is excess charges for VBAC, frequently an HOURLY fee (let the stressful ugliness of that scenerio sink in), not covered by insurance just so a doctor will actually stick around and wait out your labor at the hospital in case of emergency. How effective is that in discouraging VBAC?

 It has nothing to do with the actual risk of allowing a birth to occur vaginally with a previous uterine scar.  The risk of uterine rupture that is waved in these mom's faces is actually .5-1%.(See VBAC facts). In fact, c-sections carry greater risk, the most common being infection, blood loss, and blood clots in the mother and breathing difficulties in the newborn.Yet, moms are being refused the right to let nature dictate their birth and face forced needless intervention.

I feel your pain. It is your body and it should be your choice which risks to take, and you should be able to go to any hospital and have evidence-based care and that includes VBAC. Unfortunately, in today's climate you might need to consider a joyful and safe homebirth with a trained attendant even if that would be your last choice (It is possible, even if that trained attendant cannot yet attain legal status where you live). It once seemed crazy to me too, but I'm also a mom not eligible for a natural hospital birth due to misinformation and hospital protocols. Now, I'm becoming a midwife to give women out-of-hospital birth options.

The Beautiful Moments of Birth

birth (Photo credit: j.cliss)

Even within the most traumatic of birth experiences, there are joyful moments. I write this list for everyone who, like me, came out of a birth experience feeling less than, and as a reminder that childbirth is not all bad. This is dedicated to my children who made me who I am.

1^st birth

Rocking in my grandfather's rocking chair in dark silence moving with the natural rhythm of my body's labor.

Pacing in my grandparent's front yard. Taking in openness. My grandmother's calm reminder that everything was okay after a little admonishment about being outside in the middle of the night (she didn't make me come inside).

Not once did anyone ever mention epidural. (I had meds but nothing that actually took away the pain. It was bad, but also good.)

Lying in the hospital bed in the dark, pain suddenly became bliss as my my body gently nudged my baby out of my body. For once, I was free of all thoughts, including any realization of what was happening. I felt powerful and animal-like with no concept of time or emotion. (The nurse that unfortunately walked in on the scene may have thought I was asleep until she saw my baby's head or maybe I was making noise that caused her to turn on the light. I really wouldn't know:)

My newborn daughter was sat on a pillow on my lap (I was too shaky to hold her). She had been shrieking frantically, but then she latched onto my breast all by herself and was quiet.

A few hours later, I was able to hold her and talk to her.

2^nd birth

Alternating between pacing and lying on the floor in an overheated little apartment.

Sitting in the hospital bed drinking grape juice with my toddler daughter at my feet (waiting for a relative to pick her up).

Laughing when my son peed on the nurse attempting to put his first diaper on him.

Finally being left alone to hold my son.

3^rd birth

Making love with my husband for closeness and pleasure (Knowing he'd probably have said no if I had told him that I had had contractions all afternoon.)

Pacing the floor by myself all night. (I thought about my husband needing to rest, but really wasn't concerned about the marathon I was running in my living room.) I ate yogurt and popsicles. With nobody bothering me or giving me reasons to be concerned, I wasn't feeling bothered or concerned.

Drinking tea and my husband feeding me a few bites of chocolate silk pie even though the nurse-midwife said I shouldn't have it.

In the hospital, on hands and knees on the bed while leaning on my husband. I felt my baby moving a lot so I knew she was doing just fine. (She was probably trying to get into a better position for birth, but not much luck.)

Being asked if I wanted an epidural, and honestly being able to say no. I didn't need labor to be faster or painless. I trusted my body even when the nurse-midwife didn't.

Finally, curled up behind my husband, napping between contractions a few minutes at a time. (Unfortunately, this only happened after leaving the hospital against medical advice and the cytotec induced contractions were abnormal and dangerous, but naps are absolutely essential during a long labor. After two nights with labor pain and no sleep, staying awake just to be harassed in the hospital was not an option.)

My husband laying our new little daughter beside me so I could cuddle and nurse her.

Overall

Notice that not all of these moments were without pain, but the joy far exceeded any pain.

Many women, like me, don't want constant attention during labor. Gentle support and a few reminders are sometimes all that is necessary.

With my last baby, I drank a lot of fluids and ate a little during labor, and vehemently refused pitocin and pain meds until the last hour (had I known I was that close I could have continued to refuse, but nobody knew or they probably would have said it was too late for an epidural). This was the only birth experience where I didn't vomit and dry heave violently.

I was seriously hoping for that urge to clean house some women speak of having before a baby is born. No such luck. The pacing was far different than the normal walk I might take for nervousness or to think. It was very mindless. (Because I was worn out, the hospital should have insisted I nap (even if it took a small amount of meds) rather than trying to speed things up with meds. Common sense.)

Being out of one's mind is by far the easiest way to cope with the intensity of childbirth.

Everyone is different. Everyone has different preferences and ways of being, which might change as we grow and learn.

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• Jude's Birth Story

“Don't be a hero” or Why Natural Childbirth Is Not Masochistic

Tip of 16G Portex Tuohy needle and epidural catheter tip (Photo credit: Wikipedia)

How many times do you hear the sales pitch for the epidural? “Why be in pain if you don't have to?” “Don't be a hero.”

I'm totally not into pain. I've been known to try to hide under the covers from menstrual cramps and headaches. When I was in elementary school, spanking was still common, and I assure you the fear the paddle inspired was enough to keep me from being purposefully disobedient. No piercings or tattoos for me. By all accounts, I should have been the first one in line for drugs when it came to childbirth. If birth were only physical, I would totally agree that pain medication should be standard, but the reality is that birth is also emotional and even spiritual (or at least a deeply meaningful life event).

Nobody around me cared in the least how my babies were born so long as they were healthy. Still, I just had this sense that childbirth was sacred. My mother, and billions of mothers since humanity began, experienced childbirth without pain medication. My assumption was that unless labor was very long and/or complicated I wouldn't need medication to control the pain. Had I been encouraged to rest in the middle of labor instead of given labor augmenting drugs, I would have almost certainly had three drug-free births even with long labors and two babies in a posterior position.

It is possible for most women to actually enjoy the experience of labor. It's nearly shameful to admit that anything other than actually holding your baby was enjoyable. I'm not ashamed. I enjoyed natural labor (not medically augmented labor) so much more than the numbing epidural. The epidural made me so numb that I couldn't feel my legs for several hours after or even take a deep breath. Granted, when I requested not to be numb with my last child they were able to do that, but it was still bad for me. It calmed both the physical and emotional pain I was experiencing, but it took all positive physical and emotional feeling away too.

Birth is emotional. If you take nothing else away from my musings here, remember that. A woman in labor is often not pleasant to deal with. Doctors and nurses tend to appreciate the epidural because it makes a laboring woman much easier to examine and preform routine procedures on.

If we really care so much about “unnecessary pain” why should needles be standard in childbirth? During my third labor, I complained about the huge needle they stuck in my arm for IV antibiotics. The nurse couldn't believe I was worried about a needle rather than labor. The epidural needle (which I regretfully had twice because of unnatural drug induced pain) was like an electrical shock to my spine.

Hospital birth doctors and midwives are almost always way too quick to recommend induction or augmentation of labor, but don't talk about the pain it will cause because they can always call for an epidural to alleviate the pain, then more pitocin because the epidural slows down labor.

Pain and pleasure are separated by a very fine line. It is a delicate balance. (If this makes no sense to you, ask someone experienced in the kink community, but please don't read 50 Shades of Grey.)

Very very few moms who had a drug-free birth regret the experience, even it wasn't planned that way. A whole lot of moms who experienced medicated births do regret it, even some who planned it that way.