Friday, August 14, 2009

Things I learned from my Unmedicated Labor and Delivery with Induction

I learned quit a bit from my experience. This post is for those who really want to do unmedicated labor and delivery. It's certainly not a post for everyone. It's my honest assessment of what I wish I had known and the things that helped me achieve my goal of unmedicated labor and delivery despite being aggressively induced.

-My goal had been to have an unmedicated labor and delivery and I met that goal. So why did I feel like such a failure? I think, along with my goal of natural birth I also developed some expectations that were somewhat unrealistic. Ok maybe not unrealistic but certainly inflexible. When those did not materialize I felt like a failure. I expected it to go faster. I expected to be more "present" and have the "birth experience" I wanted. That did not happen. I felt I had been sold a bill of goods. I felt I behaved poorly or must have done it wrong becasue mine did not feel like the "zen" experience the books described. Looking back I realize it's not the fault of "natural" childbirth that mine was not "zen". However, the books need to do a better job at leveling with women just how much pain they are in for. They tend to minimize it, in my opinion. Of course, my labor being induced probably had a lot to do with that but even those women who are not induced say it much more difficult than the books lead you to believe. Not all but many.

I met my goal with pure grit. I'm not saying I had the wrong goal becasue I absolutely believe it's the safest option but I also brought some unrealistic and inflexible expectations into the situation which lead me to feel disappointed, angry and depressed about my birth experience immediately afterward. Not anymore. I have the experience firmly in perspective. I do feel proud of making it through but for months after I felt like a failure even though I met my goal becasue I yelled, screamed, panicked, became weak, indecisive, vulnerable. I expected to be clam, stoic, present, level-headed. Yep, during unmedicated labor and delivery. Totally unrealistic.

-I was not prepared for induction...not mentally, not physically, and mostly I did not have the information I would have needed to make better decisions. Yes, I have the right to make my own medial decisions. I did not have to simply acquiesce to their protocols. However, I didn't even know what my options were so I had nothing to contribute. No ideas, no requests. I was just a sitting duck. More on my induction recommendations later.

I absolutely want to have another unmedicated labor and delivery but if I am induced I am not sure I could/would be able to do that again. If you want an unmedicated birth option you CAN do it even while induced. It's possible but I'm not sure I'd want to or could do it again. It completely changes the game. As long as one is mentally prepared for that I think it's possible.

This is why I am avoiding induction at all costs. If my water breaks again I am not goign straight to the hospital. I'm going to wait around a bit and see if labor really kicks in. I might not even be honest with them about the time my water broke. Once your water breaks the clock starts as do their "protocols". This is not medical advice. Just my personal strategy.

-If I must be induced I have a whole new understanding of how I think it should be approached. I have no doubt that they were overly aggressive inducing me. To go from 0 to 10cm in a few hours....3 min contractions 1 min apart is completely unnecessary and potentially dangerous. I will firmly request to have a gentle-as-possible induction. Low doses. No increasing until at least 30 mins has passed. Once the desired pattern of contractions has been achieved they should turn it down or off. If there is any fetal distress then TURN OFF the pitocin and see if that helps. Never go beyond the recommended dosages on the packaging of the drug.

-If you really want to go unmedicated then you have to put the option of artificial pain management out of your mind. If you approach it with the attitude of "I will try it" then you will fail. Without complete commitment you WILL ask for the drugs...especially if they are offered. If you are undecided then ok...try it...but if you are committed you have to just not even think of drugs. Put it in your birth plan that the staff is not to offer drugs.

-Expanding upon the previous point...have it in your birth plan that the staff is not to mention drugs, or other interventions (vacuum, c-section, induction medications) unless it's an absolute emergency. When you are in the middle of it you will be tired, indecisive, vulnerable, scared, and in pain. If anyone mentions an alternative you might cave. You might think something is wrong when, in fact, feeling tried, indecisive, vulnerable, scared, and in pain are all NORMAL. No matter how well meaning, they should not offer. This applies to your husband as well. He will hate to see you this way. It's up to him to help you. He doesn't help you by offering you the thing you are wanting to avoid. He has to be strong for you becasue there WILL be a time when you think you can't do this anymore; that you just want it over with. He needs to be the one to get you past those self defeating thoughts. You will not be able to do that for yourself.

-I actually wrote out 3x5 cards for Mr. Peeveme with all the things he needed to say to me when I lost it. I made him promise to keep me strong. I made him read those cards to my own words. When I heard them it helped to remind me of the strong determination I have. It helped me a lot when I had no more determination or fight in me.

OK, so that's what I have for now. My friend who introduced me to unmedicated labor was the only person who level with me and gave me any inkling of what was in store. Because of her I was able to do it. If I had just depended on the books I would not have made it. So I wanted to level with you.

As hard as it is, it's still my choice. I know there are easier ways to go about it. I know that many people will read this and think "Why on earth would you put yourself though that if you can just have an epi or a c-section" My response, I'm afraid, might offend or hurt some people but here it is: This pregnancy, labor and birth is not about me. It's about my baby. It's about what is best for her. This is the first of many sacrifices I will make for her.

I am a little worried this time around because I am not feeling as strong (mentally and physically) going into this one as I was the last time. It was just so grueling that I don't know that I could or would be able to do that again.

My inflexible goals/expectations lead me to some disappointment with myself afterward so I am trying to manage determination with a certain amount of flexibility as to my expectations.


areyoukiddingme said...

I think that's where the advent of the doula has become such a good idea - having someone with no investment to help maintain calm during labor is essential. I'm about polar opposite of you in my preference of birth experiences, but I totally agree that you must enter into it knowing what can happen and what your options are.

I hope you get your "zen" experience this time.

Summer said...

Have to post this in two comments as it got long!

I completely get wanting a certain birth experience. And I think it's extremely important to know enough about what can happen so that in the midst of all that pain and tiredness you can make the best decision for the health of your baby and for yourself, too. And I fully support you or any other woman who wants to ensure an unmedicated L&D. But I do take issue with some of the things you mention in this post. ("Take issue" might be a harsher phrase than I want to use, more like some things jumped out at me that I felt I had to comment on.)

Let me first share with you that before I found out my baby was breech, my attitude was that I will attempt unmedicated labor but I was going to be open to all my choices while I was in the midst of labor since this was going to be my first birth and I didn't really know what I was going to expect. Once we found that TK was breech (and did not up to the actual C-section--he was pulled out butt first), I opted for the C-section because there was only one OB in my entire area (and I live in a rather large county in California) who had any notable experience in vaginal deliveries of breech babies. And he was in his late 70s and about to retire any minute. I decided I would rather risk the complications of a C-section breech delivery with my original OBs than those of a vaginal breech delivery with this elder OB.

One of the things you mention is that you wished the books need to do a better job at preparing women for the pain they will go through. But, from all that I have read, pain tolerance is a very individual thing as is the type of L&D each woman goes through. It wouldn't surprise me if this second birth for you was different in pain levels than your first. So, I guess I wonder how a book can explain what the pain will be like if it can be so different for different women. I think this is an unrealistic thing to ask books to describe. And how do you interpret something like, "the pain will be more horrible than you can imagine" from a book or even from someone else's actual experience? I, for one, can imagine quite horrible pain but I also know I have a fairly high pain tolerance. So, what level of pain should I expect?

From reading about what you experienced with the induction, it seems to me that you felt you were talked into it when you were not in a mental state to stand up for yourself and what you wanted for you and your baby. And it was the basis of everything that went wrong in your L&D with Piccolina. So, I can understand why you want to avoid inductions this time around. But, from what I understand about the waters breaking, the reason behind starting the clock is that after 24 hours the risk of infection greatly increases. And if an infection has started, it can get worse very quickly from there which is what the OBs want to avoid. I just want to put that out there not because I want to scare you or anyone else, but why not tell the OB the truth about when your water breaks but make it clear that you DO NOT want an induction just because it is 24 hours and one minute pass your waters breaking. That you understand your risks, but you want to see how things progress without intervention. This way everyone knows where everyone is standing and if there comes a point when medicated intervention becomes absolutely necessary for fear of your baby's and/or your health, you won't be put in the position of wondering if they are trying to talk you into something you don't want to do. I guess I say this because I believe that medicated interventions came about because there were circumstances in the past where without them, babies died and so did their mothers. I think we, in the first world (including myself), tend to forget how dangerous and fatal natural childbirth can be. Fatalities from childbirth had been high in first world countries decades ago and is still high in developing countries.

Summer said...

(Continuing with my previous comment)
"This pregnancy, labor and birth is not about me. It's about my baby. It's about what is best for her. This is the first of many sacrifices I will make for her."

I think these reasons you state for trying to have an unmedicated L&D can also be the same reasons why you choose a medicated birth, in my case a C-section. I did not want to be cut open. I did not want to risk delayed breastfeeding. I did not want to have a spinal and to be hooked up to IVs and have a curtain over my chest so that I could not tell when my baby was actually delivered. But, I felt it was the least risky choice if what I wanted in the end was a live, healthy baby. I did not get the birth experience I wished for, but I got the birth outcome I wanted.

Lastly, it seems you feel apprehensive about the upcoming birth. Not surprising given what you went through with Piccolina! But, it seems to me you have done a lot of thinking and planning and preparing and I think that is all anyone can do. I do hope you get the birth experience you hoped for, but if you don't, I hope you won't feel disappointed in yourself. The one big issue I have with people pushing unmedicated L&D (and I don't believe you are one of them, but there are people out there who feel like this is the only way to birth a baby) is that somehow you are something less of a woman if you don't feel all the pain and endure all the suffering. Childbirth, no matter how you do it, is a huge feat and no woman should be judged for the kind of childbirth they went through.

Sorry to take up so much space in your comments, but this series of posts you did was really thought-provoking for me and I'm glad you wrote them.

Joonie said...

It seems like you have completely thought through your options and are as prepared as anyone can be for your upcoming L&D.

I was so not ready for mine (being my first and being 5 weeks early)! The only thing that got me through it was remembering the words of my prenatal yoga instructor. She used to say no matter how much planning you do for your pregnancy and L&D, your baby has a plan of her own. She will come into this world in her own unique way and you have to learn to let go of some of your expectations for the birth experience.

That was the best advice anyone every gave me throughout my pregnancy.

Best of luck and lots of hugs!

Birdee said...

Crap you always speak my words and I have tears.
First - I hope nobody finds offense in you expressing your own desires and feelings about your reasons in having a natural birth. You were not criticizing anybody else’s choice, just stating your own and keeping it about you and I found it very respectable.

I also know what a contraction feels like – and a long labor, and a traumatic experience.
With my first, I had the attitude “I’ll give it a try” and I did fail. However I had NO tools on how to cope, how to keep cool, how to handle those vulnerable moments.
For me – that’s why this time I know it’s best I hired a Doula, take an intense birthing class (Not just read books or a silly 3 hour class at the hospital). I’ve been very serious and committed to having a natural childbirth.
However I have really enjoyed what you put in this post about being flexible. I’ve just come to realize lately that while I “Say” I’ll be flexible, I have felt very resistant to having things not go as planned, especially certain parts of my birthing plan.
I have put away the words “birthing plan” and adopted the words “Birthing Preferences” so that I’m not so heart set on things going my way. I don’t want to ruin something beautiful because it doesn’t look the way I think it should look, and It WILL be different.
I also enjoyed what you said about the cards you’ll have your husband read when you lose your mind.
I hired a doula to be my brain when I lose mine, and I have written down all the things I want her to remind me when those week vulnerable moments come that I’m sure will happen.
(So to me whether it be your husband or hired birthing coach – I agree it’s realistic to get SOMEONE who can pull you through, I just don’t think the odds of success are in your favor when you do it alone- unless you have a fast labor and it’s not your choice)
I have lately been bombarded with fears, and I was talking about them with a friend the other day and came to realize where the fears are coming from.
That while my brain has all this new knowledge and beliefs, my body still remembers the traumatic experience of my first birthing and I’m having a hard time bringing “Peace” in the delivery room with me. (tho I am working with my Doula and other methods to get rid or minimize these fears – thank goodness for smarter ppl than me)
Anyway, I’ll be thinking of you and praying for the both of us. We can go anytime now, and I’m terrified of having a pain med free birth that is induced with pitocin.

(sorry so long - you bring out the passion in me)

Anonymous said...

Good luck, I hope it works out for you!! I love the card idea!!! Mr. M hates it when I give him "scripts" but he may just be willing to do that!!!

Anonymous said...

I love your description of Piccolina's birth - and I'm glad you were able to stick through with no pain drugs. NOT how my birth story went, but I think it is great to see an honest account of an unmedicated birth out there. Hope this time around things are much easier and you don't have to induce!

nishkanu said...

Just wanted to say, I get where you are coming from. I hope to have an unmedicated delivery as well. Basically, my idea of an ideal birth experience is "not a c-section." This is because 1) I do not want the 6-8 week recovery time while taking care of a newborn, I saw what that was like with my sister-in-law and it was hell and 2) I do not want the increased risk of miscarriage for a subsequent pregnancy, I have had enough miscarriages already. Having said that, if there is some major emergency I am not going to feel bad if I do have a c-section, I just don't want to get rail-roaded into it as seems extremely common these days. Because I don't want a c-section, I don't want an epidural, since it can increase the chances of a c-section. And narcotics don't seem very good for the little one. So unmedicated it is. And I don't really expect it to be exhilarating or fun, just something you have to go through. Trying to stay in shape to make it doable. We'll see.

Good luck!

Kami said...

Oh, my, I hear you.

I was fortunate enough to have read the book (and taught the class for a bit) Birthing From Within which talks about how painful it is and ways to cope with the pain. Too many natural child birth books/theories sell the idea that if it isn't painless then you are doing it wrong.

And the drugs . . . my doula (also a friend) and my husband confirmed that I never once asked for drugs or to be rescued although I did often say, "I can't do this." But when my midwife suggested we should go to the hospital to get some pain relief (rather than tell us she was concerned about the heart tones) I immediately - I mean without even a second's hesitation - agreed that this was a fantastic idea and how fast could we get there? Ok, I didn't say all those things, but my thoughts were in that direction.

About the clock ticking once the water breaks - also crazy, IMO. I know I read books and am more likely to surround myself with people who believe birth is too managed by doctors / hospitals, but I do believe the time tables are ridiculous. Worried about an infection after only 24 hours? Well, maybe it is because every intern/doc and nurse has had their hands up my you-know-what. Keep your contamination out and give me some more time.

Oh, and I am scared too. I was in a lot of pain - well, who isn't? - with a baby who was sunny side up as well. I felt the urge to push only a few times but the lack of control feel really scared me. I remember feeling very afraid of what was to come when the baby actually started coming out / crowning.

The memory of the pain of labor has faded - that part I think I can go through again, but the fear that came up is still with me and I know it is something I will need to address before labor is here.

The interesting thing is that I was more "in the moment" in some ways (as in not anticipating the coming pain / loss of control) with our son who I did deliver vaginally with no intervention. I was probably so terrified about what was going to happen after the birth to worry about what was going to happen during it.

I also had many regrets and feelings of failure after the birth. I think part of that is just normal PPD. I am sure part is also that desire to have this amazing, perfect birth. Not that it is easier with the fertile, but add that loss onto all the losses of infertility and it is hard to deal with.

May it all go unbelievable perfect this time around - or as close as humanly possible.