The Unwritten Birth Plan [written]

Tuesday, April 19, 2011

How very fitting that I revisit Isaac's birth, just a week before his 2nd birthday.

I first introduced the idea that I planned to have Isaac med-free in my 36 and 37 week posts. The 36w post includes a sentence and the 37w post a paragraph. Suffice it to say, that while low intervention and med-free birth were both something that I was intrigued by and had sparking passion for, through various blogs, message boards and stories from friends I became aware of and did not want to become a part of the growing population of mother's who planned for a natural birth and found themselves depressed and disappointed with themselves all while holding a beautiful and healthy baby. This is where my severely limited moderate side comes to play, which seems to revoke my birthy badge, because while I believe that intervention and med-free birth is the most ideal way to bring a baby into this world, sometimes our bodies do fail. Sometimes informed mother's choose differently, sometimes modern medicine is life saving and not convenience driven. In these circumstances, all that matters is a healthy baby and mama. All that matters.

So as I wrote in my 37w post, our natural birth plans were essentially by the seat of our pants. I consider myself a strong person, both in mental strength, determination and for the most part physically, but I did not want to be arrogant enough to believe that these things alone could get me through labor and delivery without needing medicinal support. How could I know how far my I could go by myself, on a road I'd never traveled? As it turns out, the full distance.

For a quick refresher on the labor and delivery of Isaac [long version], I labored for almost 28 hours at home, before being admitted at around 11:00pm at 5cm. Upon hearing that I was only 1/2 way to full dilation, I asked my nurse to call for the epidural. I was exhausted and felt defeated in hearing that I had at minimum 5 more hours to go. My nurse though, was an absolute angel. She asked me about my birth plan and I said past tense that I'd wanted to go med-free. Even when I gave up, she never did. She drew the water in the tub for me, suggested a shower, wanted to call one of the volunteer doulas, basically anything she could think of to withhold administering first the IV and finally the epidural. Around 12:00am, I finally received the IV, which I was told was necessary before the epidural could be given. I've since been told this is untrue and to be honest, I don't care one bit, because that nurse, Lisa, fought me for the birth I wanted and I wouldn't have it any other way. I never completed the saline drip or received the epi, and at 1:00am my water broke, due to being fully dilated, a +2 and crowning. Isaac was born at 1:17am, just over 2 hours after admission and 17 minutes of pushing. He was caught by Lisa, as he arrived too quick for the OB on call.

Just typing the above makes me nostalgic and decidedly excited. I can't believe that I get to birth another child and bring life into this world, again. I know what an amazing blessing it is. There's just this little twinge of anxiety though, which is what led me to ask my midwife what her response would be if I asked for an epidural. I knew that she would never refuse me the epidural, but I did want to know how much she would fight me. There's this thought that has become embedded in my mind that while I didn't "give in" completely, somehow the med-free birth was not my own because Lisa was virtually the only one stopping me from receiving the epidural.

An intervention and med-free birth is hugely important to me, because I believe that my body was made for the function of birthing a child. Furthermore, after abstaining from over the counter medicines, sushi, alcohol and any number of additional things listed on the "to avoid during pregnancy list," I can't fathom willingly exposing my unborn child to opioids and narcotics. I also believe that consenting to interventions can be the initial movement that triggers an avalanche of building interventions resulting in a c-section, as illustrated by the United States national c-section rate at 32%. Additionally, I am firmly committed to breast feeding Baby Love, just as I was able to be successful with Isaac, and med-free babies are usually more alert and eager to nurse.

I don't know about you, but these drawbacks to an epidural from American Pregnancy absolutely scare the crap out of me:
- Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to make sure there is adequate blood flow to your baby. If this happens you may need to be treated with IV fluids, medications, and oxygen.

- You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect from epidural use. If symptoms persist, a special procedure called a “blood patch”, an injection of your blood into the epidural space, can be done to relieve the headache.

- After your epidural is placed, you will need to alternate from lying on one side to the other in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.

- You may experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.

- You may find that your epidural makes pushing more difficult and additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary.

- For a few hours after birth the lower half of your body may feel numb which will require you to walk with assistance.

- In rare instances, permanent nerve damage may result in the area where the catheter was inserted.

- Though research is somewhat ambiguous, most studies suggest some babies will have trouble "latching on" which can lead to breastfeeding difficulties. Other studies suggest that the baby may experience respiratory depression, fetal malpositioning; and an increase in fetal heart rate variability, which may increase the need for forceps, vacuum, cesarean deliveries and episiotomies.

- Additional results of epidurals are the need for constant fetal monitoring, which means you can't get out of bed (literally cannot because your legs are numb) and also means that you have to push lying down, known to most ineffective way to push.

Again, I would like to reiterate, that this post is simply my view regarding birth and this is essentially my birth plan: to have Baby Love med-free, resulting in a healthy mama and baby. If there are deviations from this birth plan it is for the sake of a healthy mama and baby. I don’t want anyone after reading, feeling as though I have attacked them, because I do not think epidurals are inherently bad. When a mother’s labor has stalled due to anxiety, exhaustion, fear or immense amounts of pain they feel incapable of managing, an epidural can give her body the chance to rest and in turn can actually reduce the chance of a c-section.

Conversely, I do believe that epidurals can become a stumbling block when they become overused or standard procedure, as they seem to be now. The statistics point to at least 65% of all births involving an epidural. They seem to be offered with the hospital welcome folder and are usually presented as the normal option. There is an art to administering the epidural at a precise time so that it does not interfere with the progression of birth, if this is not observed, that is when drastic increases in the rates of interventions begin. By pointing out these facts regarding the negative aspects of an epidural, I am not saying that everyone should avoid them like the plague or judging those who choose them in spite of the above. I am, simply stating the facts, and why my choice takes these negative aspects into account and how in weighing my options, I choose med-free birth.


Unknown said...

Perfectly written. I may be referring to this post in my future post about our "birth plan."

Jill said...

Yes! I love this! This sort of post is on my list of drafts that I want to write, I just haven't done it yet. This might be something that I reference in a future post too...

Great minds think alike!

Meredith said...

Love this post.

Like I said before, I've never felt super convicted about having a natural birth. The doula who taught our birthing class told us that while her preference is med-free births, if you're planning to receive an epidural, if you wait until you're dilated to a 5, it has been shown to decrease the likelihood of a c-section to about normal rates. So, that was my goal.

I did make it that far, but my contractions were 5 minutes long and 30 seconds apart the entire time I was in labor. I didn't feel like I had any ability to breathe through them, and I've often wondered if they were more "timetable", if I would have been able to go longer or all the way without an epidural.

That said, my epidural was awesome, and I really think it was the best thing in my situation at the time. It was also totally different than what most of my friends in other states have experienced (our local hospital is actually a birthing center and holds to most traditional birthing center ideals)--I could still feel EVERYTHING, but it just took the edge off a little. I was up and walking within a half hour of delivery.

But, um...yeah, STILL paying it off. It was grossly expensive, even after our insurance paid their portion.

Anyway, sorry for the novel. And even though med-free births aren't something I'm personally super passionate about, I really enjoyed and respected this post!

Randine said...

Atta girl! You can do it!! You HAVE done it :)

Anonymous said...

Fabulous post. I have the utmost confidence in you and your ability to do this again!!

Leslie G said...

You go!
I can't believe Isaac is going to be 2. REALLY?

Anonymous said...

This was well written. You are right, I think they FIRST thing they had me do at the hospital was sign a waiver in case I wanted the epidural, which I didn't. After two days of labor though I just passed out, and Q was given the option of an emergency c-section or an epidural - good thing we had discussed it! Poor Gooner, I was just contracting on her head! Anyway, it is good to have a plan. AND also know that you can get a "2 hour dose" which is what I had. My friend is a labor and delivery nurse and she said from her experience they use forceps and vacuums more regularly for natural births where the mother is just too exhausted to push and they HAVE to get the baby out, than with an epi.

mrs. darling said...

LOVE this post. you beautifully said everything i have been thinking and feeling about my upcoming birth.

Megan said...

Great post!

I can definitely appreciate this and I have all the confidence in the world that you can do it again... you are super mommy! :)

jen @ homeinthecountry said...

This is sort of exactly what I've been thinking... my body is made for this, right? So ideally, I'd just let it do it's thing until the baby comes out (sounds so easy, doesn't it! :) hahaha). But, if I need an epidural, I don't want to feel bad about it -- just happy that I've managed to bring a sweet little human into the world! :)

Janell said...

I give you credit for doing it and planning to do it a second time naturally, I just couldn't myself.

My water broke at 10:35pm and I had DS by 7:19the next morning 9 hours from start to finish. Nine hours of the most excruciating back labor I've ever experienced in my entire life, nine hours of endless contractions that came very hard and very fast so fast that I coulndn't even get through them before the next one started. I admire you for going natural but know that if I ever do it again, I'll get the epidural in a heart beat. It was absolutely divine when that sucker kicked in!

Jennifer said...

you can do it! I took a Yoga for Labor and Delivery class that made a HUGE difference for me. I don't think I would have been able to do it without it, and it gave me a degree of confidence that I really needed, too.

and can I just say how AWESOME it is to have nurses like that! Midwives aren't allowed to practice in my state, so you can imagine what the standard practices are like ...

Shannon Mac said...

Preach it! Your nurse from Issac's birth sounds amazing. How lucky you were indeed.


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