Wednesday, January 19, 2011

More advice from Doulala

These next articles and bits of advice are about pain relief during labor. This is something I am trying to learn as much as I can about. I made it through my labor with Aimee without pain meds. But this time I want to do more than just make it through. I want to find ways to ease the pain and let my body make the labor smoother as well as make it better for my baby. There were a lot of little interventions I allowed during my first birth. I am educating myself about them and trying to decide what to do next time if and when the situations arise. All of these articles are helping me find my place in the natural birthing movement.

Comfort measures are strategies designed to help you cope with the pain of labor. A good childbirth preparation class should teach you an assortment of ways to cope, as will many books.

What are some common comfort measures?                      


·  Environment:
-- dim lights
-- peaceful surroundings
-- privacy
-- warmth
-- music
·  Physical:
-- walking
-- pelvic rocking
-- positioning pillows for comfort
-- slow dancing with partner
-- sitting on birth ball and swaying
-- lifting up the abdomen
·  Touch:
-- massage
-- stroking
-- cuddling
-- counterpressure against lower back
-- acupressure
·  Heat:
-- deep tub bath
-- shower
-- heated rice sock on groin or back
·  Cold:
-- ice packs on lower back
-- cool cloth to wipe face
·  Cognitive:
-- visualization
-- affirmation
-- focusing on the breath
-- structured breathing patterns
-- non-focused awareness (paying attention to everything you see, hear,
Feel, and smell without focusing on any)
-- prayer

·  Aromatherapy

·  Vocalizing: moaning and groaning

·  Labor companion: The continuous presence of an experienced woman can reduce the use
of pain medication in general and epidurals in particular (3). The presence of male partners,
 however desirable, doesn’t seem to have this effect (7).
What are the benefits of using comfort measures?
Basically, there are three ways of handling labor pain: comfort measures, narcotics (opiates)
and regional analgesia, which consists of epidurals, intrathecal or spinal injections, and their
combinations. Comfort measures are about as effective as narcotics at making labor tolerable.
 However, narcotics can potentially have adverse effects on you and your baby. And regional
analgesia, while offering superior pain relief, can cause a host of problems not only for you and
 your baby, but for the labor as well.
Comfort measures:

·  do not inhibit labor and in many cases, can enhance labor progress: Mobility and
activities like pelvic rocking help the baby shift into the optimal position for birth. Upright
postures allow gravity to help the baby open the cervix and descend into the birth canal.
Strategies to relax muscles keep muscle tension from impeding the work of the uterus.
Cognitive techniques reduce fear. Emotional distress, as opposed to the healthy, normal stress
of labor, can interfere with labor directly through the production of stress hormones and
 indirectly by preventing women from paying attention to their bodies and working effectively
with their labors.

·  promote a sense of mastery: Studies show that the key to a positive labor experience is the
feeling that you have control over events and can cope with what is happening to you (4-5,10).
Comfort measures make you the active agent in helping yourself. This is an important
component of a sense of mastery.  

·  facilitate endorphin production: During periods of intense physical demand and stress, the
body produces natural pain killers called “endorphins.” In a case of “no pain, no gain,”
endorphins are also responsible for the exhilaration and joy that can follow such periods (6).  

·  enable you to postpone the use of pain medication: Medications are more likely to cause
problems with repeated doses, when different types of drugs are mixed, and with prolonged use.
 By using comfort measures, you may need only one dose of a narcotic instead of three, you
may avoid using both a narcotic and an epidural, or you may delay having an epidural.  

·  can instantly be stopped if it doesn’t help or in the unlikely event that it causes trouble:
So, for example, if the baby doesn’t like you to be in some particular position, you can simply
find another one. Pain medications, once administered, cannot be rescinded, and you may need
another drug or procedure to remedy the ill effects. These, in turn, introduce their own risks.  
What are the potential drawbacks?
Comfort measures may not provide adequate pain relief. This can lead to a feeling of personal
 failure if you wanted an unmedicated birth. Still, this will rarely be the case where caregivers
and loved ones respect and support your desire to avoid pain medication, acknowledge your
efforts to do so, and validate your disappointment at not achieving that goal.
How might comfort measures affect your birth experience and postpartum recovery?
As with any experience that pushes you to your limits, an unmedicated labor can be a
 transformational event that changes how you think of yourself forever. Your pride in your
achievement, the confidence in your strength and capabilities that you can gain are, perhaps,
 the ideal preparation for meeting the challenges of parenting. Avoiding or delaying the use of
pain medication also gives you your best chance of having a complication-free labor and a
healthy baby, which may mean an easier postpartum recovery.

30 Comfort Measures to Ease Labor Pain

Pushing for First-Time Moms - by Gloria Lemay

Second Stage Labor: You Don't Have To Push

The Second Stage of Labor



Is Mother Directed Pushing Possible in the Hospital? « Enjoy Birth ..

If you don't know your options, you don't have any.           ~Korte & Scaer
Mothers need to know that their care and their choices won't be compromised by birth politics.                                                                                            ~Jennifer Rosenberg
Midwives see birth as a miracle and only mess with it if there's a problem;
doctors see birth as a problem and if they don't mess with it, it's a miracle!     
~Barbara Harper

What can I suggest to my doctor to avoid or lesson the ring of fire at the end? I ripped really bad with my last birth and that is my only pain fear this time.
Letting baby come nice and slowing and while in a "good" position is great.

If you're unmedicated and laboring freely-instinctively, you will be much more likely to get yourself in a position that is more protective to the perineum.     It's normal and natural to be upright to deliver, even leaning forward in various positions.    It's not natural to recline in a bed~  this is for caregiver's convenience (and harmful to the perineum~).
So you can reiterate that it's important for you to feel free to labor as-desired, however this might be.   
(I discourage checking the cervix because not only does this cause unnecessary tension with useless information, it also can aggravate your birth canal and sphincters.    Not normal to have anyone going in there and can affect your flow-vibe).

Saying you want to avoid all unnecessary interventions will encourage freedom to labor as you prefer.    Then as baby descends you can blow "o"s with your lips, moan deep & low, especially reach down to feel baby crowning (women won't tend to tear into their own hands!), talk to baby as the head emerges:  "that's a good baby, no hurry, niiiice and sloowww.    Slowly now little one.    Let's not rush this."    You can do what you can to avoid any forcing/forced pushing, definitely no coached pushing.   (!)

Generally, the more natural & instinctive, the safer and more pleasant.
You can discuss these ideas with your doctor~  but be aware that it's not generally a doctor's training-interest to help a woman enjoy her delivery.   :- /      Getting yourself "armed" with ideas and support of your own (husband and/or doula) will be great.    Discussing this prenatally in appointments and referring to your Birth Plan are great, too.

phewwww...     That felt long-winded.  lol!
We can chat more, anytime!

So basically what I am getting is that I need to do what feels good (or as close to good as possible). Push if I feel like it and move how my body makes me move.
I think the biggest thing I'm still trying to figure out is how to get through transition. My contractions started at 2 minutes apart at the beginning of labor. I was in labor for 14 hours. The last 6 hours or so they were 30 seconds apart to no space in between. During transition all I wanted to do was push. I was almost completely dilated but still had a lip. So I was told to labor down. It was the most miserable hour of my life. Would it have been best to let myself push lightly instead of fighting it?

sorry for all the questions but I just feel so intent on figuring this all out and you are such a wealth of information!
Quoting doulala:
aww~   thanks!!    ;-)
Been around this stuff for a while, just trying to pass it on...
Ask away, sweetie, that's what we're here for!

Yes, labor is unique as we are shaped a little differently, our babies are shaped a little different, and positioned in there a little differently.
When the baby's body sends off those chemicals that say "Yep, I am ready...  NOW" then our body say "yah, okay, me too!" and together in harmony, they work to position and move and contract and wriggle and open, etc etc., bringing the baby outward.

Sometimes it's nice to have a little help~  but overall, mama knows what is better for her & baby.
I wonder if there was something else going on with your labor, fear-tension-anxiety-ill feeling (maybe someone present~ or not)-baby's positioning-health (hydration, fatigue, etc)...    Emotional & physical health and confidence affect labor.   
If you are harboring "stuff" (whether consciously or not) at that time it may affect the kind of laboring you experience.

Keep in mind what transition is:   not only is it the shortest part of labor (and most intense, frequent-hard contractions), it's the time when the body is still opening (the Grand Finale of dilating/effacing), but also when mom is getting into the pushing phase--- mom's more alert-aware, more "in her body" and present and ground, less in Laborland. 
What a freaky time, eh?!?

When you know it's temporary and surrender will mean less pain-more progress, you can focus on getting over, getting through.
Having support people there to help remind you of this is great.

I did have a good amount of fear. I never gave into that fear or screamed or anything. I stayed pretty calm. I have a serious phobia of throwing up and that was at the back of my mind the whole time. Although during transition when my body felt like it would squeeze my stomach out I did not feel sick or afraid of throwing up.
I was thinking about it and I think that is about the time my doctor came. He stripped my membranes without telling me a few days earlier and it really hurt. I remember crying and begging them not to let him  check me because I thought it would hurt that bad again.
Also I couldn't figure out how to breath or change what I was doing to get through it. I ended up doing pull ups on my Mom and Husbands arms the whole time. I knew my body needed to relax for a few seconds but I could never make that happen. Plus they let me push for a few minutes before telling me to labor down. So I knew what I wanted to do but that I wasn't supposed to. Seriously, I would have pushed for hours if I had to. It felt good compared to just laying there in pain.
wow.    :-(

I am getting a sense that that membrane stripping may have triggered some deep issues.   Like when it what Time to labor you were mentally refusing to agree physically...   Like you were fighting surrender/agreement to let it go, let it be.  

Your awareness right now is going to be helpful for your future.   
You can now know that you do have the ability to decide: "I choose not to let tension permeate my experience.   I will ride the labor (contraction) like a raft floats on the waves of the sea..."

You never need to get your cervix checked. 
You can have a doula/other support person help you to breath and to remember coping strategies. 
You don't have to do this alone~  you can have support and enjoy the birthing experience~   !