Thursday, July 30, 2009


In honor of Brynna’s birthday (Friday!), I am going to post her birth story. So a little background information is in order first. By the time we decided to have a baby, I had been through my third year OB rotation, where I saw a bunch of births in the hospital, both vaginal births and C-sections.

The OB residents who ran the labor & delivery suite are very technically competent, but are generally not so interested in low-risk obstetrics. Most of them want to do subspecialties like gynecologic oncology surgery or reproductive endocrinology. They don’t have much experience with normal labor, since they (and us, as medical students), generally went into the room to check a cervix every couple of hours, and then at the end when the woman was pushing. Few women I saw there did anything besides lie in bed with an epidural.

After watching this, and doing some reading, I realized that I really wanted to stay home in comfortable surroundings for as long as possible, to be able to move around at will during my labor, and to maximize my chances of having a normal, straightforward vaginal delivery. I was afraid of forceps, and a C-section is major abdominal surgery! With these goals in mind, we made two big decisions:

1. We chose to have a midwife, since midwives are experts in normal, low-risk deliveries. On my rotation, the midwives would disappear into a patient’s room for awhile, and then they’d come out and record the birth on the big white board. No rushing or running about or anything. That’s what I wanted! They also provided a lot of support during labor for women who wanted it. We also had the best of both worlds, because at our big hospital, if something went wrong, we could also transfer care to the obstetricians for an emergency C-section. (No homebirth midwives in our part of Minnesota, so that wasn’t an option.)
2. We started to prepare for labor without pain medication, not for the sake of being Hardcore, but because it would be necessary if I was going to stay at home for a long time, and then once I got to the hospital it would let me continue to move around and keep interventions to a minimum. There are a whole set of things that come with epidurals. You have to have an IV, because the epidural can cause low blood pressure (which is corrected with IV fluids). You usually do less moving around—which can be critical for positioning the baby well and moving the baby down the birth canal—because of the IV, and the continuous monitoring of the baby, and the fact that you might not be able to feel your legs. Labor sometimes slows down once the epidural is started, leading to augmentation with a medication called pitocin, which can cause very hard contractions, stressing the baby and increasing the risk of C-section. And because you can’t feel your pelvis very well or at all (which, admittedly, is the point!), you sometimes can’t push as effectively as a woman who can feel. That leads to a higher risk of vacuum-assisted delivery, forceps-assisted delivery, and episiotomy. (Let me add that these things don’t ALWAYS happen, and some women get great pain relief and none of these side effects, and I am in no way suggesting that my decision is the one that all women should make. It was just the one that I thought was most likely to give me my desired birthing experience.)

Most natural birthing classes are based on the early 20th century work of Grantly Dick-Read, who wrote about something called the Fear-Tension-Pain cycle. Fear (mainly of pain, since many people will tell you that childbirth is the worst pain ever) leads to tension, and tension increases pain. Lather, rinse, repeat. The goal is to break that cycle. I started researching various childbirth classes, and settled on something called the Hypnobabies Home Study Course. A woman I knew had had a great birth with hypnosis, and even though it sounded really hokey to me at first, it won out after I finished my research.

It will probably sound hokey to you, too, but here is what I learned to do: the course focused on deep relaxation, creating mental “hypno-anesthesia” to block pain in certain parts of my body, and expecting an easy, fast labor with pressure but no pain. Around 24 weeks of pregnancy, I started listening to the CDs. There were about six different tracks, and I laid down to listen to one every day (30-40 minutes) learning a bunch of different techniques to get into deep relaxation and create my mental anesthesia. I also listened to a track of positive birthing affirmations every day (also about 30 minutes) while I was walking to work or driving in the car. And I did my prenatal yoga for about half an hour every day too. Sometimes it seemed like the only time that I wasn’t at work in the hospital, I was doing my childbirth prep! Once I got home from Arizona, Alex and I worked together to finish our preparations. He learned some cue words and touches to guide me into hypnosis, and we practiced these together most evenings, before reading the crumpet her bedtime story.

Friday, I’ll post my story and you can see how all of this worked! But before then, a quick primer on labor:

-labor is defined as uterine contractions that cause the cervix to open up
-the cervix has to go from closed to approximately 10 cm open during the first stage of labor. This is usually the longest stage, especially in someone having her first baby.
-once the cervix is gone (the woman is “complete” in OB jargon), the second stage of labor—where the baby moves out of the uterus and down the birth canal—begins. This is the “pushing” phase.
-fairly soon after the baby is born, the placenta detaches from the uterine wall and also comes out (this is the third stage of labor), as the uterus clamps down to minimize blood loss.

1 comment:

Allyson Wendt said...

Off to check out hypnobirth for my January due date....