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Monday, August 26, 2013

What I Know Now That I Wish I Knew Then

In light of some of the awesome things I learned at my local ICAN chapter's August meeting, I thought I would share a few things about labor and birth that I wish I had known when Ewan was born. 


1. Don't go to the hospital as soon as your water breaks. I was in early labor for about 4-5 hours before my water sprung a leak and we called the ob, who of course told us to come in. While I was super excited that Ewan was finally making his appearance, I never should've gone in that early. If you test positive for amniotic fluid, you're "on the clock" and most providers will strongly push a c-section if you reach 24 hours after your water breaks because of an increased risk of infection. Once I had a chance to think back on it, when did the ob tell me it was time for a c-section? Almost exactly 24 hours after I had arrived at the hospital. Even though I had been in early labor for a few hours, my body did not have enough time to build up contractions to get into active labor before pitocin and the cascade of interventions that came along with it, was started. 

2. You have a right to informed consent and informed refusal. That's right, not only do you have a right to be informed of the benefits AND risks of any intervention, but you also have the right to refuse them, even if they're "hospital policy." Wow, do I wish I had known this when I was in labor with Ewan. It was the hospital's policy to automatically hook you up to an iv during labor and not allow you out of bed, even to sit up, if your water has broken. Since I was stuck in bed, my contractions slowed way down and they gave me pitocin. I was basically told that this is what was needed to happen for him to be born and never told any of the risks associated with it. While I knew that I didn't want any of that, all of the learning I had done previously flew out of my head in the moment. Did you know that 33% of first time moms will have a c-section and if you're induced, which I basically was even though I had gone into labor on my own, the c-section rate rises to 50%. 

3. A doula is imperative. When I was pregnant, I had thought about a doula, but decided against one because I thought that Alan and I would be just fine on our own. I could never have been more wrong! As I previously stated, everything I had read about the risks of interventions flew out the window during labor. My husband was so concerned with the pain that I was in with two epidurals that didn't work on one side that he wasn't able to advocate for me. A doula is just the person to do so. They're experienced in birth and can act as the go-between you and the hospital staff and translate hospital-ese and let you know what is truly necessary and what is not. We had a doula with our daughter's birth and I will never have another child without one. 

4. Decline cervical checks. I know that we're all anxious to see if we've made progress, but every time a foreign object is inserted down there, the risk for infection goes up. It's no wonder infections start after 24 hours of your water being broken...you've probably been checked a bazillion times! At the very least, I would only allow the doctor to do checks to limit the exposure to foreign objects. I found out through reading my records that I likely had an infection when Ewan was born even though no one told me. While I knew not to allow cervical checks before labor, I never thought about it during and it was always the nurses doing the checking, not my doctor. That infection was definitely something that could've been avoided. 

5. Decline third trimester ultrasounds. Did you know that your chance of a c-section rises dramatically if you receive an ultrasound after 24 weeks? After I thought about it, this totally makes sense. If you start "measuring big" your doctor will almost certainly want to check baby's size. However, your due date could be off or you have a ton of fluid or that could just be your normal. Unfortunately, a lot of the time, the "big baby" card is played on women, where their doctor tells them their baby is going to be huge and that they need to be induced early or even have a c-section because they won't fit through the pelvis. Unless you have uncontrolled gestational diabetes, this is almost completely untrue (true cephalopelvic disproportion occurs in only 1/250 pregnancies). Our bodies are made to give birth, I am proof. I was told that because my son was 8lbs8oz I would never be able to have a vaginal birth because he was too big, so no future baby would fit. Before I switched ob's at the end of my second pregnancy, my original ob kept ordering ultrasounds because I was measuring three weeks ahead. I personally knew Cecily was going to be big considering the size of Ewan and other family members when they were born. My last appointment with her before I switched she kept "cautioning" me over and over that trying for a vbac was a big mistake because Cecily was going to be huge and that she could die due to shoulder dystocia....You have no idea how much I would've loved to have seen her face when she found out I successfully vbac'd my 9lb8oz daughter! A baby isn't considered to be truly big unless they weigh over 9lbs15oz, Cecily was a full half pound below that. And, ACOG (the American College of Obstetricians and Gynecologists) has stated that a big baby is not a reason to induce/cut. Oh yeah, my ob also told me that I have a "wonderful pelvis for birthing babies."


6. Baby's position matters, but it's how you respond to it during labor that matters the most. Ewan was posterior and asynclitic, basically meaning he was face up and wedged sideways in my pelvis. This type of labor is long and arduous and the best way to get baby out of this position is for mom to be moving around in different positions herself. So, if you're hooked up to all the monitors and whatnot or if you have an epidural, particularly an early epidural, you aren't able to move around like you should to help baby through the pelvis. Positions such as squatting and being on all fours do wonders to open up the pelvis for baby.

7. Birth Matters. It is not only about having a healthy baby. Of course we all want that, but how a mother feels about the birth experience matters just as much.

It's great that there are so many options for childbirth but it's unfortunate that many doctors out there don't inform their patients of the benefits and the risks of each and/or they induce/cut for their convenience. It's so sad that I have such a distrust for maternity care in this country. Hopefully you don't have the experience I did the first time.

6 comments:

  1. I agree 100% with all of this! Even the ACOG is now saying that a "big baby" is not a valid medical reason for induction, but OBs still do it.

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  2. Wow...I didn't know any of this. It's a bit scary how much you should be aware of!

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  3. Chris's mom gave birth to 4 babies all of which were larger than Ewan, and she did it with minimal (or no) intervention. If she can do that back in the 80s, we can do it now!

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    1. That's what I kept telling anyone that told me Cecily was going to be huge :-) If my grandma could deliver three 10 lb kids with no interventions in the 1940's-1950's then so could I!

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  4. very well said! btw my mom also delivered me breech - vaginally.

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  5. As a doula in training this just breaks my heart. I wish you had had a doula too. I love educating women on their choices and preparing couples for what they're going to possibly go through. I'm so glad to see posts like this so that other women can also be aware of things that might go wrong, and the options they have available to them.

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