NPR -Doing a GREAT Job With Articles

Aug 162011
 

Npr has been having a plethora of articles on labor and birth. The Baby Project. They are packed full of information and power for a pregnant woman. Here is one that a client sent to me to help understand her fears of her upcoming labor. The article seemed to resonate with her concerns. I am going to address some of the things and how they could be handled differently. This is the second half of a birth story that was begun in a previous article. The Broken Epidural.

“However, due to HIPAA regulations, I was separated from Frank while a nursing assistant asked me 100,000 admission questions. Didn’t we pre-register to avoid this? I constantly repeated to anyone who would listen: “My husband has a copy of my medical records.”"

Recently a mom came in in active labor to the hospital with me along side of her- her doula. The mom’s husband was moving the car and she wanted me to stay with her. But due to the privacy act of HIPPA, I was asked to leave the room. She was about to be alone with a nurse she had yet to learn the name of and answer questions of a personal and private matter. I had been hired to help her with pain coping techniques and this nurse was dismissing me. I asked later what we could have done to avoid that as this had left my client feeling abandoned.

You can waive your privacy rights and tell the staff that you want your doula or partner to stay with you. It is your right to waive them. This could have been offered to her but it was not. But knowing this now- I think it is important to understand it may be hospital protocol to have your support people leave, but you can refuse it.

“Yet the hospital’s system required that I give fresh answers to inane questions such as, “Do you remember when you had your last period?” while I was having intense contractions. There were also incredibly vague questions like, “Do you have any medical issues?” Later, a resident came in to ask me the same questions yet again and when I mentioned a tonsillectomy a few years back, the nurse’s aide admonished me, “You didn’t tell me that!”" Continue reading »

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Pain Scale Question

Jun 132011
 

When in labor you will probably be asked this question: On a scalre of 1 to 10, with  10 being the worse pain you have ever felt and 1 being no pain, where are you on your pain scale?

http://denverhealth.org/LinkClick.aspx?fileticket=TFyVg2WioCI%3D&tabid=3623

http://www.pain.com/go/default/practitioner/medical-library/expert-interviews/the-need-for-new-jcaho-pain-standards/

This scale was determined to be used by hospitals for pain control and management. If you had surgery and had postoperative pain this is useful. It is not useful when someone is having labor pain to focus on levels that are not anything she has ever felt before.

PAIN : purposeful, anticipated, intermittent and normal

Purposeful pain alerts us to action. In labor early pain tells us to alert support, go to where you are going to be birthing, hydrate, call the midwife, etc.

Anticipated pain readies us for being prepared by taking classes, learning pain coping skills, understanding our options. To go into labor not anticipating pain means you are going to be shocked when your body goes into labor. Anticipate it- welcome it- as it brings your baby closer to being in your arms. The fear- tension- pain cycle that Dr. Grantley Dick-Read wrote about tells us that if we fear it- we tense more and the pain is more difficult.  So know it may be painful- not so painful you can’t do it- just painful- so prepare!

Intermittent pain means it is not ongoing- in fact if you have contractions 3 minutes apart- that is twenty an hour- and if the peak is the part that is the most difficult, you are looking at less than 7 minutes of difficult pain per hour. It is not like having constant pain- it is intermittent. So, try to go with the intermittent time between contractions- use it to rest- to recoop. Then ride the wave during those seven minutes and think about surrendering to it, not fighting it.

Normal pain means what you will be feeling is normal. 300,000 women will birth with you on the day you give birth.  Birth is not so painful that we should not want to do it again. Our species relies on it. Birth in normal.

So, keep the pain scale for the pain that is not purposeful, not anticipated to have to be present, not intermittent and not normal. And keep this skill out of the labor room!

If you are asked about this pain measurement, know that you can tell the staff you decline being asked further.

 

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Endorphins

Jun 032011
 

Yesterday when I went to get an additional tattoo.  I sat in the chair and thought I was ready. When David put the needle to my back, I had second thoughts. It hurt! I told him that he needed to be prepared for some whine! I had to remember to take a deep breath and release my shoulders. I also realized how much I rely on music when needing a distraction for pain. David had forgotten to turn on the music. He stopped when I mentioned it and turned on his music for me.

The full tattoo took an hour. He worked mostly straight through with a few breaks to take care of other business and give me a chance to check it out at the mirror. But what I realized was that after about fifteen minutes of David putting the needles to my skin, the sharp pain that was at the beginning was gone. I am sure the music helped distract me. I am sure that the great conversation I have with David each time also helps.  But it also dawned on me that the pain receptors in our bodies had sent more endorphins to me to help me with the pain. I did not even consider the last 45 minutes of being tattooed as painful at all- instead a sensation that was uncomfortable but not grimacing in any way.

Continue reading »

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epidural issue…

Jan 032009
 

I had a client in 2008 who desired a natural birth but after several hours without any change in dilation, interventions were begun and she ended up with a cesarean birth. She was my only doula client who ended up with a primary cesarean last year. She had stayed at 8 cm for several hours and then received an epidural. The effects of the epidural dropped her blood pressure causing the baby to go into distress and her cesarean was immediate. I hate that it happened. I am not sure we could have done any more than we did. Perhaps if she had been able to relax more- given more time before getting the epidural… I don’t know. But the thing that caused me the real problem with this birth was not the outcome per se.

This hospital, Emory Crawford Long, does not allow a laboring woman to have anyone stay with her if she chooses to get an epidural. NO ONE- as in not her husband or her doula or her friend or her mom… only medical staff. Why?

Let’s hear from the nurses…on allnurses.com the forum had these comments: Continue reading »

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Epidural Safety

Dec 312008
 

Epidurals have become so common place that I think many folks feel they must have no risks at all. So, I thought I would write about some of the risks you need to consider. First let me give you a definition of an epidural from an anesthesiology website “Epidural anesthesia is most commonly placed in the low back (lumbar region). Unlike Spinal this technique may also be accomplished in the mid-back (thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the Epidural need will be placed. The needle for Epidural passes between the vertebrae of the Spinal column to the Epidural space. Once the position is verified, a very small catheter(tube) is placed via the needle. The needle is then removed and the catheter remains in the Epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter. The procedure usually takes 10 – 25 minutes.”

One great website with a fabulous article is http://www.healing-arts.org/mehl-madrona/mmepidural.htm

The doctor writing the article posts these concerns. Continue reading »

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Fear & Fatigue

Nov 302008
 

The Two Big Factors in Labor and Birth

 

As a labor doula there are two factors that I think make the most difference in labors. The first one is fear. Pam England says that the work of pregnancy is worry. We need to get all our fears out on the table and address them one by one. That way when labor begins, we have gotten the fear factor out of the way and we can labor. When a woman is holding onto some hidden fears she does not allow her body to unfold and birth. This truly inhibits the mind-body connection that is so essential for birth to flow more easily.

Some of the greatest fears are not unique to most women. There is a fear of loosing control. The concern about pooping when they are pushing out their baby. There is concern that their behavior will be such that they will be embarrassed by it later. There is the issue of trust for their provider and the location where they will birth. Will their partner be supportive enough? Will this experience enhance their relationship or hurt it? Will their body “fail” them- not opening properly or not being able to withstand the pain? Will they have to fight for what they want? Will they allow something to happen that they will later regret? These are just a few of the concerns most women share with me. The answers or solutions are as varied and individual as the concerns. I do know that these concerns need to be addressed long before labor begins so that these same concerns won’t inhibit the natural process of labor. Continue reading »

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