Sunday, April 12, 2009

Appropriate Use of Intervention & Medication for Labor

By now, you know that I believe that fear is NOT a reason to have an epidural. The lack of education and preparation are the reasons, I believe, that the majority of American women choose to have pain medications in labor. This is also why women are choosing to have a C-section, never experiencing a single contraction -- fear.

You might be shocked to know that I believe that there are appropriate times for intervention and/or medication. I'd like to share such an experience one of my "DVD couples" had this past week. It's been several days since I spoke with her and I've had a birthday party for my 3rd child, a baptism, company, and Easter, all take place since our conversation. Some of the details are fuzzy, but you'll understand my point without all the details.

They were planning a homebirth and this was their first baby. Labor started on its own, as it should, and she labored for a number of hours with contractions about five minutes apart. They spaced out to 10,15, 20 minutes apart after a time. It would pick back up though and continue for hours at five minutes apart again. Several hours into the labor, she had an appointment with her midwife. She had a vaginal exam and found that her water had broken -- probably in the bathtub because she wasn't aware of that happening -- and was told she was 100% effaced and dilated 3 cm.

She continued laboring at home throughout the day. Her midwife checked in on her that evening and still, she was dilated to a three. This is where my memory fails me. I do not remember at what point they decided to go to the hospital, and really, it doesn't matter. She was near the 24-hour mark of water breaking, but everyone was doing fine. Her cervix just was not dilating. When she arrived at the hospital, they did start her on pitocin, but not terribly high. They also started her on antibiotics as a precautionary measure because of the ruptured membranes. It should be noted, there was no sign of infection. She labored this way for 4 hours and still did not dilate past a three.

I just knew this story was going to end with surgery. The doctor, who was the back-up doctor for the LM, suggested at this point that they increase the pitocin and she have an epidural. She had only slept a few hours during the labor and was exhausted. This was a hard decision for her -- I could hear it in her voice when she told me that she consented to the epidural -- but she made the right decision.

She slept during the next few hours while the pitocin took over. The next time she was checked, she had good news! Her cervix was dilating! She labored the last hour without pitocin or the epidural and pushed her baby out on her own.

Had she not listened to her medical team, who, I must add, was giving good advice, she would have had a C-section. Yes, she did not have the quiet, undisturbed homebirth she had planned for, and there will be some emotions there to deal with. But she avoided surgery. Why did this happen to her? Who knows. Maybe it was about the baby's position. Maybe she couldn't relax enough. Maybe she was apprehensive about giving birth at home, even subconsciously. She may never know. But she will, I believe, be able to have a peace about her birth. She used intervention and medication, not because she was afraid of the process, but because she needed that assistance.

I have another example from another DVD couple last fall. This was to be another out-of-hospital birth, but she went almost 3 weeks over her "due date." Her biophysical profile, etc., had been good, up until this point. Her midwife had become concerned, if I remember correctly, with fluid levels and thought she should go ahead and be induced at the hospital. She had a great back-up doctor. This mom was induced and labored without an epidural for many hours. She remained dialated to a nine for several hours when the cervix started to swell. This is not a good thing. They recommended an epidural so she could relax and sleep. It worked. She had a vaginal birth.

Sometimes, we (okay, I) focus so much on the "evils" of medicated birth, we loose sight that it can sometimes help avoid surgery. I would absolutely rather see a mom have a medicated birth than a C-section. These were good doctors who wanted the same thing for these moms. They respected their wishes and were anxious to help them achieve this goal. Many doctors would have just done a C-section on both of these women.

I can honestly say that I don't know what could have been done differently to avoid having medication or intervention in either of these labors. Had they not been planning out-of-hospital births to begin with, they likely would have ended up with c-sections earlier on. I do believe that planning homebirths, even though they both transported, were contributing factors to still having vaginal births.

Both of these women were educated and prepared. It reminds me of something our midwife with our 3rd baby told us: "Birth is 90% in your head and 10% what happens to you."

1 comment:

Lena said...

Great post Donna!