Empowering Birth Blog

Premature Labor?

My friend just had a 72 hour labor.  WOW, 72 hours, now there is a number that could get a mom really discouraged.  It was preterm labor (35 and 1/2 weeks) and her midwife offered morphine to help her rest (which would mean staying at the hospital), I suggested home, rest, hot bath, and wine.  So this birth has gotten me thinking about two things.  One, when is a mom in labor, and two, what is a good way for mom to get rest/slow down contractions.  I don't think I am ambitious enough to tackle both in one blog post so let's start with helping mom rest/slowing down labor.

In Spiritual Midwifery, Ina May writes:

"If there is no bloody show and there is no or very little dilation of the cervix (less than 1 cm), give the mother a full glass of water followed by a glass of wine.  Alcohol is a depressant, and it suppresses the release of oxytocin from the pituitary gland.  It works well for stopping labor in the third trimester.  Alcohol should not be given in the first two trimesters to inhibit labor because of possible damage to the developing baby.  The woman should stay in bed and everything should be as nice and quiet around her as possible."1

Now my friend was 4 centimeters dilated, not one, but the midwife was offering morphine so my thought was, if wine works (and there is no history of alcoholism in the family), why not?  And the wine was indeed a tremendous help.  It slowed down my friend's contractions, helped her manage a long labor, and possibly helped keep the baby in her an extra two plus days, which got the baby a lot closer to 36 weeks.

So a few days after my friend's birth, I was listening to the tape on Prolonged Labor by Diane E. Barnes, CNM and Gertrude L. Welsh, CNM, NP from "Midwifery Today's Clinical Tape Package" and the CNMs were discussing ways to help mom sleep when she is faced with a potentially long labor or just really needs some rest.  Instead of morphine, they recommend 50mg of Vistaril and 1000 mg of Tylenol.  If the mom's contractions are more painful, they suggest giving a Tylenol #3 (with codeine) in addition to two regular Tylenol). Apparently the midwives have had success promoting the Tylenol/Vistaril combination to hospital doctors as an alternative to morphine.   Among other things, lack of rest, nourishment and hydration can also encourage pre-term contractions, so before tackling the problem of how to help mom rest/slow down those contractions, you should ask mom are you hydrated/how much rest have you had/what have you been eating, etc. etc.?

Which brings me to another thought.  One of the midwives on the tape noted that she didn't believe in Braxton-Hicks contractions before 36 weeks.  She felt that contractions before 36 weeks were due to an irritable uterus or a sign of potential preterm labor.  What an interesting way to think about uterine contractions.  If there is no such thing as Braxton-Hicks contractions before 36 weeks, then if you experienced contractions before 36 weeks, you might think to yourself, I need to hydrate/rest/nourish myself.  If Braxton-Hicks contractions can be experienced before 36 weeks, you might think to yourself, oh, there goes my uterus again.

In any case, my friend said no to the morphine, returned home after laboring in the hospital for a while, took a few hot baths, rested, had a glass or two of wine, and these things seemed to slow her labor down, keep baby inside for a few more days, and gave her the energy she needed to birth her baby when the time came.  I should add that my Midwifery Tape on Prolonged Labor did not recommend wine due to fetal alcohol syndrome, but if Ina May recommends it, alcoholism doesn't run in the family, and you are in your third trimester, I can't help but think it seems like a good idea.  A mom I know who is German mentioned that a glass of wine or beer is a common recommendation for moms in early labor.  What do you think?  Oh, and if you have Spiritual Midwifery, there is a great birth story on page 70 of a mom who uses wine to stop pre-term labor.

Post to be continued....

1 Ina May Gaskin, Spiritual Midwifery, Fourth Edition (Summertown, TN:Book Publishing Company, 2002) 425.

Wait on the Epidural

I don't know why I couldn't get epidurals off the brain last night, probably the conversation I had with a wonderful friend walking home from School Information Night.  Too often I feel that if I can just find the right way to put things, the perfect example, people will understand my point of view on an issue.  Not that they have to agree with me, but they will say, "oh, I see what you are trying to say, that makes sense."  Of course I cause myself a lot of grief with this particular way of looking at the world, but I must admit, I am quite satisfied with the latest gimic I used in my prenatal yoga class.  It wasn't my idea, a friend and fellow midwifery apprentice suggested it, took me a bit to figure out how to pull it off, but it worked!

So here's what I did.  At some point in the class I have the women kneel, tuck their toes under, and then sit back on their heels (yes, it puts a LOT of pressure on those tucked toes, if this is easy for you, wait a minute, it probably won't be after awhile).  The pain caused by sitting on your tucked toes simulates a contraction, and I help the moms work through the pain using different breathing techniques, etc.  It was the last class and we have been working on this for awhile so I had them sit through a couple minute and thirty second contractions instead of the usual minute contractions.  On the last "contraction," as I could see the face grimacing begin and sense the shooting pain that was going through each mom's toes, I pulled out a bottle of Vodka and offered everyone a shot.

The first reaction, every mom burst into laughter.  Lesson one, humor can be a life-saver in labor.  Each mom stayed on her tucked toes and laughter rolled through the room.  The moms returned to sitting as I explained the second reason for offering the shot.  Pregnant moms should take the same wariness of having drugs in yoga class into the delivery room.  Is there a difference between having a shot or two of vodka at 36 weeks pregnancy or an epidural when you are only 3 centimeters dilated?

If you absolutely must get the epidural, choose it only if the benefits outweigh the risks.  In my opinion, the biggest risk is ending up with a cesarean for failure to progress or an OP baby that fails to rotate and can't find his way out because you have lost your mobility.  Once you have assessed that you really need an epidural to relax and give birth, FIRST make sure that:

1. you are at least 5 centimeters dilated (not 4-5 but a solid 5)
2. the baby is at 0 degrees station
3. the baby is in a favorable position for birth

Finding out the baby's position is going to be the hardest task ahead of you.  Chances are you might have a resident laboring with you because your doctor is in the OR performing a cesarean.  A resident is probably not going to be able to tell you your baby's position.  In this case, WAIT.  You don't want to get an epidural only to find that your baby is asynclitic or OP.  These positions require a mobile mom to facilitate turning the baby or, if the baby won't turn, finding the position that increases the width of the pelvis/hip squeezes etc., so that the baby can be born in the position he/she is in.  Yes you can turn a baby once the mom has had an epidural but you need a labor doula who knows her stuff and a partner and their job is a HECK of a lot harder with the epidural in place (the Labor Progress Handbook by Penny Simkin and Ruth Ancheta can show you how.) 

Here is a link that offers some more ideas for giving birth successfully with an epidural:
http://pregnancychildbirth.suite101.com/article.cfm/childbirth_with_an_epidural
Giving birth successfully with an epidural is a LOT of work.  I would argue that it requires having a doula present who knows her stuff because your hospital is most likely not going to have the time or the resources to provide you with a doctor who can hang out with you during your entire labor, catch a poorly positioned baby, and make sure all goes smoothly. 

So if you can do it without the epidural, I say GO FOR IT.  The the rewards are worth it.  Stay tuned for a clip of an AMAZING birth video tomorrow.  You only see the kind of glee and ecstasy shown by the mom in this video in normal, unmedicated birth.

That said, I it is definitely not useful to be completely against the use of drugs in labor.  There are times when an epidural might mean the difference between having a vaginal birth or a cesarean, in which case, go for the epidural.  I know a mom, for example, who had incredible sciatica during labor.  The intense pain of sciatica, which was far worse than labor pain, prevented her body from softening and opening up.  A light epidural helped her get some relief and birth her baby.  Do your research and choose a provider who will not push an epidural on you unless he/she feels it is TRULY necessary in your case.

Oxytocin- The Love Drug

Oxytocin is a big part of our reward for making it through a medication-free labor. Although midwives and Michel Odent sing the praises of oxytocin, the love hormone, there hasn't been a lot of evidence that oxytocin prepares mom for bonding with their babies.  In this new study, moms with higher oxytocin levels "engaged in more personalized bonding-related behaviors that facilitated a more exclusive bond with their infants -- behaviors and actions not easily duplicated by another person, like singing a special song to the infant or bathing and feeding them in a special way."1  Additionally, ""We found that initial levels of oxytocin (first trimester) predicted bonding-related thoughts...as well as maternal 'affiliative' behavior to her newborn."2  Now if only those studies had looked at the affect of epidurals and other drugs in labor on oxytocin levels and bonding.   Studies have shown that epidurals in labor interfere with the release of oxytocin:
http://www.blackwell-synergy.com/doi/abs/10.1034/j.1600-0412.2002.811107.x?journalCode=aog

http://www.compleatmother.com/epidural.htm

So when labor gets tough, remember, the good drugs (oxytocin) are just around the corner.


1 Megan Rauscher, "'Love' hormone helps mom and baby bond," Reuters Health Information, Tuesday, October, 23, 2007, http://www.nlm.nih.gov/medlineplus/news/fullstory_56520.html, accessed, October 27, 2007.
2 Ibid.

What your doc won't tell you

It is a common scenario.  First-time mom has been in labor for hours, she is tired but determined, doctor suggests, "Would you like something to take the edge off?"  The risks of what is being offered are not forthcoming, merely the tempting prospect of pain-relief (perhaps an analgesic, which actually means without (an) pain (algesic)).  Mom says no the first time but when drugs are offered a second and maybe even a third time her defenses are wearing, she begins to think maybe she should just give in, and she agrees.  Asking a mom if she would like drugs at a tough spot in labor is like waving an ultra-rich triple layer chocolate fudge cake in front of a dieter's nose announcing it just came out of the oven, wouldn't you like a teeny tiny slice?  Moms, please tell your doctors, before you go in to labor, that YOU will be the one to ask for pain relief if you need it.  And while you are weighing the benefits and risks of various drugs in labor, check out this informative blog post.

Why you shouldn't just "get the drugs"

Women giving birth need:

• freedom of movement (read Active Birth by Janet Balaskas)
• hydrotherapy (using water for pain relief, women should have the freedom to move in and out of tubs and birthing pools and have hand-held shower heads to direct on their belly and lower back),
• a strong labor support team (that can give massage, aromatherapy, words of strength and encouragement when times are tough, place hot and cold packs on mom, help you on the birthing ball etc. etc. etc.). 
• to feel safe and comfortable during labor (which might mean no medical students at your birth, laboring in your favorite pajamas, keeping the lights off, laboring and birthing in the privacy of your own home etc. etc.)

I believe the reason the epidural rate is so high is that most moms are missing one or all of the above methods that contribute to women staying on top of the pain of labor.  In the Listening to Mother's Survey1 while close to 50% of the moms used breathing techniques and position change to relieve pain only a small percentage of moms (only between 4 and 7%!) used a birth ball, immersion in a tub or pool, hot or cold compresses, shower, music or aromatherapy.  I can't imagine giving birth without having my choice of music filing the room or the use of hydrotherapy.  I am sure there are exceptions to the rule but I dare to argue that the majority of moms who advocate "getting the drugs," have not had a strong labor support team providing a variety of techniques to help them cope with the pain of labor.   As a result, many moms have a negative labor experience and are only too happy to get the drugs.  Trust me, I've been there.  When I got the epidural before my cesarean with Khady I was EXTREMELY grateful.  My epidural arrived after hours of forced pushing without any drugs while lying on my back hooked up to the monitor with the doctor coming in and out exclaiming "that baby isn't coming out."  I had had enough!

During the second birth experience, between the labor pool, my gospel music, the hands of my supportive doulas and husband, the back massage, the compassionate eyes of my midwife, pain medication was the furthest thought from my mind.  Moms, you can do it!  Labor can be TOUGH but with a good support team, it is manageable, and there are delicious parts of labor and after the birth where you are soaring high, feeling amazingly strong and invincible, as if you just might have super powers.  Many moms change their entire view of themselves as a woman based on a single empowering birth.  Look at the face of the mom in this group of photos.  Sometimes a picture says it all.  Please visit Women in Charge for some empowering birth stories and photos and make sure you have the freedom to use the above pain-relief methods if needed during your labor and birth.

11 Eugene R. Declerq et. al. "Listening to Mothers II, Report of the Second National U.S. Survey of Women's Childbearing Experiences." Childbirth Connection, October 2006. http://www.childbirthconnection.org/article.asp?ClickedLink=205&ck=10068&area=2.