Thursday, July 3, 2014

Labor hopes & wishes

I know, I know.  Labor does its own thing.

Believe me, I learned last time: there's not much you can control if your body refuses do what it's supposed to do, unlike some people I envy know.

But we also learned a lot that I hope will be positive in helping me reach a different outcome.  A lot of the proverbial what not to do's.

So, in no particular order, here are a few of the things I'm keeping all my fingers and toes crossed for on D day:

1. My water doesn't break before labor starts.  Because, though I'm pretty much resolved to ignore the doc's advice to come into the hospital right away, there's immediately a ticking clock on labor if that happens.  I'll only have so much time to get it going and get it going strong before I do have to go to the hospital, which means that I'll be subjected to all the monitoring and checking that comes along with it.  All of which may effectively shut down any labor progress I've made.

11 p.m., just a couple of hours before leaving for the hospital.  If only I'd known what was in store.  I SO wouldn't have been smiling.

2. To be well rested beforehand.  If last time is any indication, my labor is a marathon and not a sprint.  Maybe that's not even the comparison - I'm a little closer to the Tour de France.  Sure, I may shave a few hours off of the 24 it took to git 'er done last time, but I'm pretty sure I can be a whole lot more effective in the birthing process if I haven't been awake for like 40 hours in a row.

Ahhh... 3 a.m.  Seriously, quit smiling, kid.  You have no idea.

3. That I can move around.  A lot.  This is one I definitely learned my lesson on last time through.  Sure, we walked.  I bounced and bounced and bounced on the birthing ball.  I tried to move and change position.  But because I'd already been up for nearly 24 hours and it was 2 a.m. before I even arrived at the hospital and I wasn't progressing very quickly, I also rested.  Maybe more than I should have.  It was a delicate balance between moving to help labor progress and trying to save my energy - a balance I'm hoping I can do a better job of achieving this time through.  Not to mention, without being tethered to a gazillionty wires (all of which definitely hinders the entire process).

6:00 p.m. and we're finally getting somewhere.

4. That I can eat during labor.  Again, if I'm in the hospital because my water has broken, this is a no-go (though... I'm pretty sure this is another rule I may flirt with breaking).  Remember that marathon comparison?  Nobody does that without being properly fueled.  There's lots of good research that cites the importance of eating during labor, and the ways it can contribute to positive outcomes for mommies.  I'm so getting on that train.

5. That gravity will be my ally.  At the end... after 23 hours and a whole ton of stuff had been done to me, I still had to push for over an hour.  And, like an idiot, I chose to do it on my back in bed (largely, probably because I couldn't feel a lot of what I should have been able to feel because of all the trial and error issues with the epidural.  Ideally, that won't be the case this time because there won't be an epidural).  Yeah, let's not make that mistake again!  NO VACUUM!  NO VACUUM!  Poor, poor little Logan.  No vacuum is up there at the top of the list of things I hope I can rectify this time around.

This moment.  Breathless.  Tears.  So worth every second of pain, before and after.
 I've been doing a lot of research on what is and isn't part of "evidence based care" as opposed to the "cover your A" care often enacted in hospitals due to insurance or legislative restrictions.  It has been extremely eye-opening, and maybe more than a little worrisome.

For example:

Evidence-based care for you means freedom of movement, freedom to eat and drink as you like, intermittent auscultation to monitor your baby’s heart rate during labor, one-to-one continuous support by someone who is educated in childbirth, water immersion for pain management, privacy so you can focus, no vaginal exams during labor unless there is a specific reason for it or you want to know your dilation, and freedom to push in whatever position feels comfortable to you.  It includes interventions when medically necessary and not before.

Contrasted with what we typically (and I, certainly - pretty much exactly this) experience in hospitals:
...Strapped into bed with belts for continuous monitoring of your baby (this kind of monitoring has an over 99% false positive rate), no food or drink allowed (they might give you ice chips), no one-to-one support, maybe a tub for water immersion, but you can’t get in if you’re on monitoring belts, an automatic IV into your hand that hurts and makes it hard to move, lots of interruptions by people wanting to give you vaginal exams (that serve absolutely no medical purpose, but increase your odds of infection down there), and constant pressure to “hurry things along” with medication or “give you a break” with an epidural.  It’s unlikely that anyone will tell you the significant risks of medications that speed things up (Pitocin causes fetal distress, which is a #2 cause of C-sections) or the downsides of an epidural (primarily, that you won’t be able to move around to get baby positioned better, which makes it much harder for him or her to descend through the birth canal and can result in a need for episiotomy/forceps or vacuum or even surgery!). (via)

Most of all, though, the thing I hope and wish for at the end of the day is a happy, healthy baby

I'd like to be happy and healthy, too if we can swing it. 

So although I've said all these things, my number one concern is going to be for the baby, and all other decisions will be made out of that very important perspective.  All the rest of these are just ideas to help me even up the odds a little in the face of what will probably be a difficult day.  I'm not heeding my own advice from two years ago and electing for a c-section, so fingers crossed that one doesn't come back to haunt me.  

And, I now know enough to know that if I'm just not progressing, it's okay to do the epidural and then pitocin - in that and only that order.  

I'm kinda, sorta ridiculously excited.

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