Can't Have an Epidural? Let's Make a Game Plan!

If an epidural is not an option for you, it might be helpful to stack the cards
in your favor as much as possible.  It's time to make a game plan!


Here are my top 10 tips when you can’t have an epidural.


Tip #1 - Take a quality childbirth class.

Not a crash course, or one that happens to be at the nearest hospital. You need a well-rounded class that will help you understand all the tips listed below, as well as comfort measures. You need to know what to expect, the options available to you, how to cope, how to get baby into a good position, and get psyched to do this!

Do not skip this step. Even if you have taken a class before. There are many great childbirth classes out there. Do your research, talk to the instructor, and get a good outline of what they will teach. Don’t just take a class that is going to teach you how to breathe, or how to relax. While those things are great and even necessary, it will benefit you to learn many other hands on techniques as well.

Bonus points if your class will teach you the benefits of going natural (i.e, the hormones in labor)

Tip #2 - Hire a doula.

You're going to need someone to help you remember the stuff you learned in class.  Someone to help you get through this as fast as possible.  It doesn't matter how good your spouse is at helping you.  A doula is a professional.  She knows birth inside and out.  You're going to need all the support you can get.  Studies show that women who receive continuous support from a doula, are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, and their chances of having a cesarean were reduced! In addition, their labors were shorter, Pitocin augmentation was used less, and their babies were less likely to have low Apgar scores at birth.. --2012, Hodnett et al.

Bonus points if your doula knows spinning baby techniques, and has experience with unmedicated births.

Tip 3# - Scope out your hospital and your provider.

This is where your childbirth class and your doula will both come in handy. You need to make sure your hospital and your provider are familiar with natural birth. You need to know what pain relief options are available to you and are allowed. For example, do they have wireless monitoring available, tubs, showers, etc. What other forms of medication can they provide you? (See tip # 10). If you are planning a birth center or homebirth, then ask your midwife about the hospital you would transfer to, should that need to happen.

Bonus points if you do your research and find that the only hospital that will fully support your choices is an hour or more drive, but you are willing to drive that far, because you know how important a supportive environment will be!

Tip #4 - Use a tub or a shower.

This goes with tip #3. If you can find a place where you can labor in a tub, this might be your life saver. We don’t call it an aqua-dural for nothin’ :-) You may have to switch providers, and even place of birth, but if you can’t have an epidural, you may really want a tub available to labor and possibly birth in. If your hospital doesn’t have a tub, ask if you can bring one in (your doula or childbirth educator may have resources on where to get one locally). Try laboring at home in your own tub until active labor. 

Bonus points if your place of birth and your provider does waterbirths!

Tip #5 - Consider using a TENS unit.

When I am working with a mother who cannot have an epidural I ask her two questions: “Does the place where you are birthing have a tub?” and “Would you be like to use my TENS unit?” Obviously I am a huge fan, but you do have to meet the requirements and your provider has to be okay with it’s use too. I’m not going to explain what they are in this blog, but you can read about them here. A TENS unit may help you to relax and may help increase your natural endorphins (your natural pain killers). It’s best to start it in early labor, but if you skip that part for some reason, it’s still something in your bag of tricks that just might help you get a little further in labor without feeling the need to climb the walls.. I do suggest a TENS unit that is made for labor, as that has shown to have the best results. There are TENS units out there given to people from a chiropractor, or their physical therapist, and while they can help, it is best to use one designed (or preset) for labor. Unfortunately, TENS are not readily available everywhere, and as previously mentioned, you do have to meet the requirements to use one. I’ve not had a mom yet that needed to have an epidural-free birth, use the TENS and tell me that they would not use the TENS again for their next labor. Not everyone will love the TENs, but it's worth trying!

Bonus points if your doula is trained in TENS and double points if she has them available to use!

Tip #6 - Stay home in early labor, maybe even active labor!

Most women are relaxed when they are in their own familiar environment. It’s nice to be able to move around without asking permission, to lay down in your own comfy bed, to light candles and eat and drink as you’d like. Most hospitals and providers prefer women (who are in the low-risk category), stay at home until they are good and active anyway. Napping in between contractions helps you to reserve your energy for later, and it’s almost impossible to do this at the hospital where machines are beeping, and nurses are asking you a million questions - not to mention taking your vitals and messing with the monitors every few minutes. The more rested you are, the less pain you’ll perceive later. The more relaxed you are, the better the flow of oxytocin and endorphins - both of which you’ll need to have a faster and easier labor. Having a doula with you will help you relax and help you decipher when it’s time to head to the hospital or birth center.

Bonus points if stay home and relax until active labor, have a doula to help you at home, use a TENS unit, take a good childbirth class so you understand the stages of labor, utilize hydrotherapy (when not using the TENS), and choose a place of birth where they will be hands off if you do get their too early!

Tip #7 - Relax

Relaxing encompasses so many of the other tips listed her...having a doula, using the tub or shower, staying at home when possible, etc. If you can, use them all. Relaxing can also mean sinking in and letting go. Try tensing a muscle somewhere on your body right now. Now let it go, now try to get it to relax even more. Lay down and try that with your feet, your legs, your bottom, your back and shoulders, your face, your arms...you get the idea. You will learn how to do this in your childbirth class, and it will benefit you to practice.

Bonus points if you practice relaxation techniques on a daily basis.

Tip # 8 - Spin that baby.

Head down is half your battle, but it will also help if baby is facing the right direction. A posterior baby may cause a longer labor, and sometimes they have a harder time coming out. A good childbirth class and doula should be able to show you what causes this, and how to prevent it. A doula that is knowledgeable in spinning babies, is going to help you have a shorter labor, if you are able to do what she suggests. 30% or more of all babies start out posterior at the onset of labor...don’t think it can’t happen to you. If the doctor does an ultrasound and says baby is in a great position, don’t assume that he/she will stay that way. It can change on a dime. Continue to do what is necessary to keep baby in a good position! If you can’t have an epidural, the last thing you need is a longer labor :-)

Bonus points if you begin practicing and living these techniques at least 4 weeks before your baby may arrive.

Tip # 9 - Bring in extra support - but don’t make it a family reunion.

Throughout history, women have provided other women with support during childbirth. If you have a spouse, then I wouldn’t be surprised if they are #1 on your list of people who will be there to support you :-) The second person on your list, would be your doula. The third person is that extra woman in your life who will mother you. It might *be* your mother, but it can also be a close friend, relative or even another doula. Someone who will mother you, but can also be strong, and willing to provide an extra pair of hands, and heart. Imagine you leaning on your main support person, while your doula squeezes your hips. The third person can be grabbing the water for your to sip after the contraction, keeping the wash cloths cool, going for food runs - and doing whatever else needs to be done, so that there is no interruption of support. She is there to help the doula, to help dad, and to be the pintch hitter when dad needs to sleep, or the doula needs to rest. Most often, a doula can do all of those things without extra help, but in a long birth, it really does help to have an extra pair of hands ready to go. That being said, the laboring mom has to be comfortable with everyone in the room. If you can’t shower or pee in front of that person, then she isn’t ‘the one’. This person should also be ready and willing to leave (the labor room), at anytime the mother requests it. A person who feels watched in labor, or feels uneasy with anyone in the room, may actually take longer. This is why I say you should not make your birth into a family reunion. If there are people in the room who are watching the clock, or talking too loud, or are even just sitting there in the corner doing nothing but looking at their phone - it is a distraction to everyone. You support people will need a place to sit when they can rest anyway. Distractions slow labor, and well meaning comments can slow labor too, (like when they turn to the doula and ask “how much longer do you think this will take”?) Consider the type of person you are. If you are a very private person, then it might be best to keep your support to your spouse and your doula.

If you are birthing at home or in a birth center, make sure your support person is completely comfortable with this!

Bonus points if your support person has given birth unmedicated.

Tip #10- Know your options.

Narcotic pain relief, nitrous oxide, pudendal blocks*, sterile water injections etc are some other medical ways you might get some relief.. Depending on the hospital and provider, you might have more than one option for pain relief, should you really need it. This is where scoping out your place of birth will be helpful along with talking to your provider. If you are birthing at home or at a free-standing birth center, talk to your midwife about the options available at the hospital you might transfer to. There are some birth centers that offer nitrous oxide, narcotic pain medications, or both.

Bonus points if you can find a place with a provider that offers all of the alternatives!
 

* Pudendal blocks may be contraindicated in a mother with low platelet

 

Medical Disclaimer:
The information on this website and blog is meant for basic informational purposes only.
It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their health.


Baby Things You Don't Need

As a mom of six children, I have become a minimalist when it comes to babies. With your first, you tend to go overboard. You get sucked in by all the cute and handy items, and click everything on the registry. By the third baby, you just tell people you want the basics: Diapers, pads, and sleep.

As you put the final details on your nursery, and you wait for your upcoming baby shower, you might want to re-consider the following items:

A Boppy

Although they come in many cute styles, I don’t find them very useful for what they are made for (nursing). Unless your boobs hang down to your belly button, you’ll end up needing to prop pillows under it anyway. The " My Breastfriend" does seem to work better than the Boppy for getting baby up where you need him/her to be, but you will most likely ditch any nursing pillow after about a month anyway! Consider getting some new sleeping pillows, and prop them where you need them in those early weeks, and you’ll have something that serves as a dual purpose!

The Gentle Rocking Swing (whatever)

If you considering a swing that brags about how gentle, calm, and soothing it is, - just keep walking. You don’t want something that is going to gently rock your baby. A baby likes MOVEMENT, and the swings that they are coming out with these days just don’t cut it. The Lamby-Poo Cuddly Pro swing looks comfortable (and probably is), but you might want to consider the Rocket Launcher 3000. Yeah, that should do it. (Patent Pending- Trisha Blizzard)

Crappy Nursing Pads

If the nursing pads have “paper” as the first listed ‘ingredient’, then you are probably a masochist, and you’ll enjoy them throughly. There is nothing worse than sticking something akin to sandpaper on your probably-all-ready-sore nipples. Not to mention they don’t hold more than three drops of milk without ruining your shirt. You need something soft, and you need something that will soak up a gallon of milk when your milk comes in. If you are like me, you will need to buy stock in these nursing pads, because you will need them for the ENTIRE time you are nursing (at least on one side), others will find themselves lucky enough to not need them after a month or two.
 

The Diaper Trash Thingie

You know the one that you stick the diaper in, turn the lid and it’s supposed to encase the diaper, and then you can’t smell the it anymore? It holds like 25 diapers at a time, and when you pull it out it looks like a giant diaper sausage. Umm no. They lie. It still stinks, and you have wasted a ton of money buying refillable bags, only to ditch the whole thing 2 weeks postpartum. Do yourself a favor and just get a small trash can and empty often. Have them all over the house, because let’s face it, at 2am, you are not going to walk into the nursery and change the baby on the changing table, and use The Incredible Diaper Thingie. What will really happen is you will change the baby on your bed, and toss the diaper in the nearest thing that resembles a trash can and deal with it in the morning.  (Unless you enjoy not sleeping?)
 

The Pee-Pee Teepee:

I used the actual name this time, because you just can’t make this stuff up! The idea is that if you are having a boy, and have these wonderful pieces of cloth handy, you will be saved from getting sprayed. Let me tell you what I learned from having 5 boys. You do not have time to grab anything. You open the diaper and if his weapon is standing at attention, you COVER IT BACK up (with the diaper). Seriously, how many moms open a diaper, covered in poo, and think “oh yes, I need to get that Pee-pee Teepee on before I attempt to remove his soiled clothing from around his neck”. No this mom is wondering if she needs gloves and a Hazmat suit.

No wonder you first time moms are soooo tired! The next time I hear a mom crying because she was up all night because it took her 3 hours to change her baby’s diaper (½ hour to find the Pee-pee Teepee, ½ an hour to clean up from the blow out, and 1 hour to figure out how to get the diaper in the Incredible Diaper Thingie), I’m going to have sue one of these company’s for mental anguish and trauma.

Parents , do yourselves a favor, and get something useful for you and your baby! For example: A doula? Postpartum doula? Or how about that Rocket Launcher 3000!

 

About the Author:
Trisha Blizzard is a mother of six and is a certified childbirth educator and labor doula in Fort Worth, Texas.

 

Omega 3's in Pregnancy Benefit Mother and Baby

Studies show that most women are deficient in omega 3 fats. 
Did you know that Omega-3 deficiency is responsible for 96,000 premature deaths each year?
That’s 96,000 too many!

Omega-3 fats are a derivative of DHA (docosahexaenoic acid). It is found throughout the body but is most abundant in the brain, eyes and heart. Omega 3's help make a stronger cell membrane - keeping the good stuff in and the bad stuff out. They help feed myeline making cells (the electrical conduits), which help send nerve signals faster to the brain. They literally make your baby smarter! DHA makes up 15-20% of the cerebral cortex and 30-60% of the retina, so it’s absolutely necessary for the normal development of your growing baby during pregnancy. When baby is deficient it can lead to a lifetime of unexplained emotional, learning, and immune disorders.

Omega 3 fatty acids help inhibit the production of an enzyme called cyclooxygenase (COX), which produces the postaglandin hormones that spark inflammation. Where there is increased inflammation, there is risk for all kinds of health issues. Research shows that omega-3 fatty acids reduce inflammation and help reduce the risk of chronic diseases such as heart disease, cancer, and arthritis. Symptoms of omega-3 deficiency include fatigue, poor memory, dry skin, heart problems, mood swings, depression and poor circulation.

Since a fetus is dependent on the omega-3 fat from its mother’s diet, and a baby is also dependent on the omega-3 fat from his mother’s breast milk, it’s essential that women have adequate supplies. Most women do not get enough from diet alone. The requirements during pregnancy have not been established, but likely exceed amounts when not pregnant. The problem is e. that during pregnancy a woman has restrictions on what she can eat to get the adequate amounts for her and baby. This might be where Omega 3 supplementation might come in handy. I won’t go into the types of Omega 3 supplements (there are two basic types, animal and plant derived), the resource links below will provide you with some information to get you started on your research.

ASK YOUR CARE PROVIDER IF IT’S OKAY FOR YOU TO START TAKING OMEGA 3 SUPPLEMENTS!

Fishing For More facts on Omega 3’s?

• The average woman eats only 150 mg per day, but it is has been recommended that she get in 1000 mg per day while pregnant and breastfeeding. (600mg should contain Omega-3 DHA)
• Reduces the risk for pre-eclampsia
• Decreases depression
• Boosts the effects of antidepressants
• Plays an important role in preventing, stabilizing and/or treating a multitude of ailments
• Steadies mood swings
• Reduces the risk for preterm birth
• Reduces inflamation which can lead to chronic illnesses
• Helps with vision for both mom and baby
• Promotes a healthier baby – less likely to develop allergies and asthma!
• Baby will have a higher IQ
• Improves hand-eye coordination, motor skills, and attention span
•Reduces risk for chronic diseases

References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621042/

https://www.drsearswellnessinstitute.org/resources/healthy-tips/nutrition/omega-3s/

http://www.uppitysciencechick.com/brunner_omega_3_oily_fish.pdf

http://www.uppitysciencechick.com/kendall-tackett_j_midwif_wom_health.pdf

http://articles.mercola.com/sites/articles/archive/2009/11/17/Omega3-Benefits-Baby-Brains-and-Eyes.aspx

http://www.greenmedinfo.com/blog/61-health-benefits-omega-3-fatty-acids

The Healthy Pregnancy Book, by Sears, Holt, and Snell

Medical Disclaimer:
The information on this website and blog is meant for basic informational purposes only.
It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their health.

Suzy couldn’t get an epidural, & it can happen to you!

serenitybirthservices.jpg

Once upon a time there was a mom named Suzy expecting her first child. As her tummy grew, her fear of birth also grew, but she found comfort in the fact that she would get an epidural in labor and she would have a painless labor and delivery. All of her friends had an epidural and encouraged her greatly in her choice. Many said “get it as soon as you get to the hospital”, and others said “don’t be a hero, just get it as soon as the contractions start hurting”. That was her plan.

Suzy did not take a childbirth class. “What a waist of money”! she thought. “Childbirth classes are for people who want to go natural”, she foolishly told her husband when he asked if they should sign up for a series. All of her friends discouraged taking classes. They took a class at the hospital and didn’t learn anything. It was boring. It was a waist of money. Suzy believed with all of her heart they were right, so the only thing she focused on was preparing the nursery while she read some information on line about recovering, and newborn care. She was excited to meet her new baby, and as she got closer to her due date, she started looking forward to her pain-free birth.

Suzy went in for her 39 week OB appointment. Along with other normal complaints, Suzy was telling her doctor that she was starting to get itchy on her belly and her hands. Her doctor ordered some blood tests and mentioned she might have to be induced. This was great news! She was tired of being pregnant, and she was going to see her baby soon! She anxiously waited for the call, and it came shortly after lunch the next day. The doctor confirmed his suspicions and told her that she would need to come in to the hospital for an induction the following morning. Yes! That was the news she was waiting to hear! Then the doctor’s tone got a little more serious “Suzy?
“Yeah...” she said nervously
“You won’t be able to have an epidural, and if you have to have a cesarean, you will have to do it under general anesthesia."
“WHAT?” Suzy exclaimed. Panic, fear, anger, and started to set in. She felt dizzy and shaky. She sat down, and asked again. “What do you mean? I don’t understand...”

“Your platelet count is getting to low to safely get an epidural”, the doctor slowly answered - “sometimes this happens with your condition”.

Suzy was still a bit confused. “Why can’t I have an epidural, I thought everyone could get an epidural”? Her doctor explained that her platelet count was too low and that increased her risk for bleeding, particularly, bleeding into the epidural space - and sometimes that can lead to permanent paralysis. Suzy felt queasy and light headed. Then she had an idea! “Can we just schedule a cesarean instead?” Suzy was just as terrified of a cesarean as she was of giving birth naturally. She never really let her mind go "there" because it was such a terrifying thought, but now she was finding some hope and comfort in the thought that maybe she could just get it over with and see her baby sooner!

“No, Suzy, I’m afraid that isn’t the best option. With a cesarean you are at more risk of bleeding, so a vaginal birth is going to be much safer for you. Did you take any childbirth classes”? Ugh. There was that dirty word again. Suzy was irritated. “No” she said quietly. “Don’t worry”, her doctor replied, “we’ll get you through it, I’ll see you in the morning".

Suzy stayed up late that night reading as much as she could about her condition. She tried to find tips on how to have a natural labor. She fell asleep in bed with her laptop open and before she knew it the alarm clock was going off and it was time to head to the hospital.

I don’t need to go into a ton of details. Suzy had a very hard time dealing with the contractions. Pitocin induced contractions are usually harder than contractions that come on their own. She couldn’t remember half of what she read about how to cope with the pain, and the things she did remember couldn’t be used because of her limitations of movement. She was strapped to a monitor that could only reach a few feet. She screamed, she cried, she withered in pain. Her husband cried in the corner, helpless and defeated. She begged for a cesarean, and after several hours, her doctor agreed that a cesarean would take place later that evening. In the end, Suzy had a healthy baby, but the memory of her birth left her feeling deeply depressed and symptoms of post traumatic stress syndrome was rearing it’s ugly head. Eventually, Suzy became a big proponent of women being educated on epidurals. She didn’t want people to go into labor without realizing that NOT having an epidural IS a possibility, and that taking a good childbirth class, is important not matter what kind of birth you are hoping for. Suzy did go on to have 3 more children after that, and she gave birth to them all without medication - not because she had to, but because she chose to. She has come to find some healing from her first birth experience. Suzy is a survivor!

Suzy couldn’t get an epidural, and here are 7 reasons why you might not get one either:

#1 - Low Platelet Count:

This was Suzy’s situation. Low Platelet or Thrombocytopenia occurs in 7-8% of pregnancies. In a way, Suzy was a little more fortunate than some moms - she had some advance warning. That’s not the case for everyone. Some women enter the hospital in labor, and won’t find out until their labs come back after admission. Keep that in mind if you are heading to the hospital and plan to get an epidural 10 minutes after you arrive. It can take at least 30 minutes to get enough fluids in and blood work to come back before an anesthesiologist will touch you.

The most common causes of thrombocytopenia in pregnancy are as follows:
Gestational thrombocytopenia (70%)
Preeclampsia (21%)
Immune thrombocytopenic purpura (3%)
Other (6%)

Normally, you have anywhere from 150,000 to 450,000 platelets per microliter of circulating blood.
Thrombocytopenia can be defined as platelet count less than 150,000. μ
Each hospital and/or anesthesiologist has their own comfort level on when an epidural can and cannot be used. For most, if it’s below 80,00 they will not do an epidural, others have more rigorous guidelines and platelet count will need to be above 100,000 for an epidural.

#2 - You are on medications that interfere with blood clotting.

See low platelet count. It is possible to have an epidural if the provider can take the mother off of the medications a few days before a scheduled induction.


#3 - You can't sit still enough.

This probably goes without saying, but if a person can’t sit still through the procedure, there is a chance of putting the needle where it shouldn’t go. An anesthesiologist may stop the procedure if it gets too risky. That being said, most women manage even in serious labor with heavy-duty contractions going on.

#4 - They don't have time.

You’ve probably heard that you can’t have an epidural after X centimeters. This isn’t always the case anymore. Here in the DFW metroplex, I’ve seen moms get an epidural at 9.5cm! I’ve also heard of cases where it is given during the pushing stage - but this is generally when things are going slow, not fast. There are still hospitals and anesthesiologists out there that have a rule about how late you can get an epidural, so it’s always best to talk to your provider about that in your prenatal appointment. Usually when they don’t have time it’s either because mom walked into the hospital too close to pushing time and they don’t have the time to run the IV fluid bolus and get labs back in time. They will still try to get it all done, but sometimes baby comes anyway :-) There are some hospitals that do not employ anesthesiologists around the clock, so in some cases, mom will have to wait for the anesthesiologist to get to the hospital first. Usually she can still get the epidural, but sometimes birth happens too fast! Occasionally, a smaller hospital with only one anesthesiologist means that people have to wait their turn. If a mom asks for an epidural and that anesthesiologist is in the OR, he/she may not be able to rush to your bedside until they are done. Again, it’s just a matter of timing and sometimes the timing works against us.

#5 - You have an infection at the site of needle insertion.
If you have an infection and the needle picks it up on the way in, it can give a free ride for that bacteria to your insides. This can lead to even bigger problems. Like epidural abscess. Not something you want to mess with!

#6 - Doctor can't get it into the right space.

If a patient has spine issues such as a deformity, or has had spinal surgery, an epidural can be a little harder to do for some anesthesiologists. Sometimes you can schedule a consult with an anesthesiologist during your pregnancy to discuss whether or not you are a good candidate for an epidural. Still-that doesn’t guarantee that the anesthesiologist on call that given day can do the procedure, or won’t need to try more than once to get it right. Each person will be considered on a case by case basis during labor, regardless of what you’ve been told previously.

Larger women, (those who might fall into the “morbidly obese” category), may also have trouble either getting an epidural, or getting an epidural that actually works. Placement of an epidural - or spinal needle in an obese patient can be difficult because the extra padding may obscure landmarks such as the midline and inter-vertebral space. Repeated attempts at needle insertion may be required, the failure rate is higher, and there is an increased risk of them puncturing the dural space. Using an ultrasound machine to help find the landmarks has shown to be helpful, so ask your anesthesiologist if that is an option.

Another thing to consider, is that studies have shown that morbidly obese women have an increased risk for lowered blood pressure and prolonged fetal heart deceleration's following an epidural anesthesia during labor.  http://www.ncbi.nlm.nih.gov/pubmed/21864821

#7 - Mom is actively hemorrhaging.
I’m sure it stands to reason that when mom is bleeding too much, there are bigger concerns going on. The reason why an epidural is contradicted is because epidurals tend to lower blood pressure. Women who are actively bleeding also tend to have lower blood pressure and the two together might bring it down even more.

Keep in mind that each person and situation is different. Some women will still get an epidural with the listed contradictions, while others may not get an epidural for something not on the list! These situations are rare, but they do happen, and I have supported moms through these births. Thankfully, most of them knew ahead of time that an epidural may not be in their birth plan. For those who did not expect it, they were very thankful they had the support and education to get them through.

As for those who planned an epidural and it didn’t work, or it didn’t work as well as they hoped? Well, that’s a blog for another day :-)

If you are reading this because you too cannot have an epidural, you may find this short blog helpful as well:  Can’t have an epidural? Lets make a gameplan!

Resources: http://emedicine.medscape.com/article/272867-overview#aw2aab6b3
http://www.ncbi.nlm.nih.gov/pubmed/21864821
http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/modernmedicine/modern-medicine-feature-articles/management-cesarean-delivery?page=full

 




Hiring a Doula for a Cesarean Birth

When people think of doula’s, they think natural birth. Some people even think homebirth, or birth center births, but did you know that most all doulas support hospital births? Did you know they can help you through a cesarean too?

The majority of my clients birth in a hospital, and I’d say that about 85% of them also want to go without medication (mainly wanting to avoid an epidural). Some of them don’t know if they want medication, while others hire me to get as far as they can without it. I support them all, no matter what their goals, planned or unplanned. For me, it doesn’t matter what kind of birth a mother wants as long as she is making an informed decision. My point is, that a doula will support a mother no matter WHAT kind of birth she wants, and furthermore she is still worth it. Maybe I will do a post sometime on how a doula can support a medicated birth, but today I want to focus on how a doula can help with a cesarean.

Some of my most precious births have been cesarean births. The mothers did not plan a cesarean, but circumstances did not make a vaginal birth an option. Most of the moms had time to process the situation, and we had time to cover the options they might still have some control over. I provided them prenatal support, birth support, breastfeeding support and postpartum visits in the home for those who wanted it.

So what does it look like when you hire me as your cesarean birth doula?

Prenatal support 24/7:

Just like any other pregnant mom, you’ll still have questions! From “I think I’m losing my mucous plug, but I was going to go swimming, is it okay?”, to “what can I do for this sciatic pain?” It’s nice to not have to bug your care provider for the small stuff, and your doula will let you know when a call is warranted! A doula also carries with her a list of trusted referrals for just about everything from acupuncture to postpartum depression.

Prenatal Education:

The doula that helps with cesareans can still provide a LOT of education. For me, this is where being a childbirth educator AND a doula comes in super handy!

I like to start my first prenatal visit off with collecting as much information about the pregnancy and situation as I can. I provide my clients with options they didn’t even know they had for their birth. We discuss family centered cesareans, delayed cord clamping, types of suturing available, as well as the procedure, and recovery. I listen to and address the fears, obstacles, and ideas they have to make the experience the best possible.

The next prenatal covers newborn care, because no matter HOW you give birth, you still have the same baby to take home :-) My clients get my full “Newborn Basics” class, complete with handouts and a book that provides access to videos on everything from cord care to bathing. We usually take some to talk about the pregnancy, and any other things that may have come up since our last visit.

Finally, to build a stronger rapport, I offer an additional class. For those who want to breastfeed, they take me up on my Breastfeeding Basics Class. We discuss how this will look for her cesarean birth, and the options that she might have depending on her unique situation. Since I am familiar with most all hospitals in the Fort Worth area, and some on the Dallas side, I can provide feedback on if her breastfeeding goals are in line with the hospital she is birthing at.

For those not breastfeeding, they make take me up on my Happiest Baby Class - because who DOESN’T want a happy baby?! Again, this is just another chance for mom and dad to get to know me better before I share such an intimate day with them.

Birth Support:

 I like to talk to mom the day before the cesarean via phone or Skype. We go over last minute jitters, concerns and questions. We talk about when they would like me arrive, and what they would like my support role to look like.

The day of the cesarean, I arrive an hour or two prior to the cesarean. If mom and dad want to keep it light, we laugh, if mom and dad want help calming nervous, I’m on it. If they want to pray, we pray. I want to be calming, and reassuring. I am sometimes the sounding board for the range of emotions that mom and dad might be feeling on that day. I might rub legs, feet, hands or do scalp massage. If the surgery is delayed and dad needs to eat, I can stay with mom so she isn’t left alone. We go over the plan one more time, and make sure that everyone’s role in the room is clear. I answer questions and provide information on what is coming next as nurses come and go. When mom goes back for her sugery, she is as ready as can be expected. I make sure dad gets suited up properly (as dad can’t go back for about 20 more minutes). If we are at a hospital where the doula cannot go back, I’m prepping him on comfort measures, and filling his pockets with all the things he needs to get through the next hour.

If I am allowed to go back to the OR, I provide the comfort techniques, and do my part as discussed previously. If baby has to go to NICU for any reason, dad can leave mom without worrying that she is being left alone. After the surgery is over, I help with breastfeeding (if that was in the plan), and help mom through the first hour of recovery. After mom, dad and baby are settled, I leave and tell them to call me if they need any help, and let me know when they would like a postpartum follow-up visit. For a scheduled cesarean, I am usually with my clients at least 4 hours, but have been there as long as 12 when needed.
 

Postpartum Support:

I offer mom and dad a postpartum visit. This looks different with each client. Some want to go over newborn care, some need help with breastfeeding. Some moms just want to talk about postpartum recovery ideas, while others need hands on help around the house. I provide them with a time line of their baby’s birthday, and I make sure they know that for the next six weeks, I’m still available 24/7 for questions or concerns.

My cesarean support varies from client to client just like a vaginal birth does! I might spend 8 hours total with one couple, and 36 total hours with another because everyone has different needs. Each doula will provide a different approach, so ask your doula what her support might look like for you :-)

If you are one of those people out there trying to decide if you should hire a doula for your cesarean birth - ask yourself if you would hire one for your vaginal delivery and why. You may have been able to justify the cost with a vaginal birth because you know that your partner may need time to eat, time to sleep and that the birth might be long and hard. There are many women out there that didn’t regret hiring a doula for their fast births. Don’t you deserve support no matter how your baby enters this world? If you want someone who can guide you through the process, and make it as smooth as possible, hire a doula! She is going to guide you through this unfamiliar territory, and make this the best experience possible. She’ll show you some things you didn’t know existed or were possible.

If you are one of those people out there shaking their heads, wondering why you should hire someone to comfort you through the most amazing day of your life - then you are probably good to go without one. Some women look forward to their cesareans, have no fears, or concerns, take newborn classes at the hospital, and will call a friend if they need a referral.

If I had the money, I would hire a doula to take me to the dentist (oh wait, I did that once!), to be their for my first (and hopefully only), colonoscopy, and I would have a doula with me when I die :-) My husband has always been there for me, and a doula could never replace him. However, he can’t take the place of my doula either!   Sometimes, it really does take a village.





"Morning" Sickness

 

Warning, if you are already queasy, you might just want to scroll down to the bullet points after the sign “How I survived morning all-day sickness”.

 

You’d think I would have had a clue I was pregnant when I craved chili, ate half of it, went and threw it up, and then went back to eating as if nothing ever happened.  I didn’t usually eat when I was sick with a stomach bug, but I just figured it was a weird, mutant stomach bug. Sure, another clue might have been that I missed my period, but then again, I thought I just didn’t remember because I had been so sick. Had I been sick that long? It was the beginning of December, and I remembered I wasn’t really feeling that well over Thanksgiving. Maybe I had my period and forgot? I do remember getting out the pads when I started cramping sometime in November, but wait, I think I put them back again. I was too sick to have a decent memory.

As the days went by I grew sicker and sicker. I had never felt sick and hungry at the same time. Food never sounded so awful to me, and yet I did feel a little hungry. Nothing made sense! My husband would run out and grab the first thing that sounded good, and then watch me run to the bathroom after about three bites and not want anymore. He asked if I thought I was pregnant. “No”, I said. “You don’t get *this* sick when you are pregnant, and besides I’m sick ALL day, not just in the mornings”. I called my parents, and asked for them to pray for me. I was convinced I had some type of stomach cancer. I was so sick that after Christmas vactation was over, I asked my husband to take me over to my sisters house to watch me while he went to work. (I didn't want to die alone :-)  It was then she told me she thought I was pregnant. She assured me that I was not dying, and that I had morning sickness. She also told me that morning sickness really meant “all day” sickness, and that I needed to take a pregnancy test. That night, when my husband came to pick me up, my brother-in-law took him down to pick up a pregnancy test first. It took about 20 seconds after I peed on the stick to show a bright pink positive. I was still in shock, but at least I knew why I had been *so* sick.

The books I read about pregnancy assured me that at about 12 weeks, it would be over, and I was almost there!  I found out the hard way that my baby forgot to read the manual. It was somewhere around 15 weeks my doctor told me that I lost any more weight by the next visit he would put me in the hospital. I was trying! Everything sounded horrible, and just passing a Taco Bell sign made me want to pull over hurl.

I remember sitting at Denny’s and ordering cream of brocolli soup and asking the waitress ‘to hurry please’. She brought it to me quickly and I ate as much as I could, and begged my husband to leave before he got his dinner because the smell was making me sick. He got his food to go, and we ran out the door as fast as we could. At least I made it out the door. The bushes weren’t so lucky.

I did stop throwing up at around 22 weeks, but I was still nauseous all the time. Around week 25, the nausea went completely away and thankfully it didn’t come back until the next pregnancy.

With baby number two, I caught on a lot quicker. The morning I woke up craving a chili dog with onions, mustard, and jalapeno peppers (something I had never ate before), I had a clue. The craving was so strong, that I woke up, went right to the store for all the fixings, came home and devoured two dogs, and then an hour later visited the porcelain bowl. I went to the store and bought a pregnancy test and was not surprised to see a positive this time. Thankfully it didn’t take me long to also discover what helped ease the terrible ‘morning’ sickness.
 

The number one thing that helped me was the thing I was terrified of – eating.

I was so nauseated, and food sounded horrible, but that is what my body needed. I also found that I just couldn’t eat a lot of anything without getting sicker. The key was to eat a little at a time, and to stay on top of the nausea, I had to keep eating. It was more like grazing, or snacking. All.the.time. Nothing sounded good, and I needed to eat. A lovely catch-22. At the very first sign that I was nauseated I would eat something, usually with some protein. Almonds were a go-to for me. I froze them, and somehow that made them easier to eat. I would eat maybe 2 or 3 and that would stave off the heavier waves of nausea while I looked for something with more substance. It might have been a hard-boiled egg and a piece of toast. An hour after that, I was ready for lunch. The *second* I felt queasy I knew I had to eat *something*. I also found that sugar was a trigger food for me. It made me feel worse. Much worse! Even fruit had to be eaten after I had some protein in me. Saltines? No thanks, but I would happily eat chips and salsa from my favorite Mexican restaurant. I also craved lemonade with salt. Weird, but it helped.

Another thing that causes morning sickness is that new found super-power - the sense of smell. I'm sure there is a purpose, but it does not help when we are nauseated 24/7.

I had no idea what was in my parent's kitchen that made me so nauseated. I looked everywhere for whatever *it* was, but never did find it. It was probably at the bottom of the deep freeze out in the garage. I learned very quickly, that the smell of garlic and onions were a definite trigger, even though when not pregnant it is one of my favorite smells when cooking dinner. I had my poor husband eat outside on many occasions. I also found that citrus and spearmint smells helped calm the nausea a bit too.

For me keeping something in my stomach at all times and avoiding bad smells were huge.

There a few other options you can try if you are still feeling like you are going to die at any minute. I haven’t tried all of them, but you might find one or two things that might help ease things up a bit. Hopefully, *something* will give you a tiny bit of relief, but first
 

Let's Recap!

  • One of the main keys to morning sickness is to eat protein!
  • Eat often - really often!
  • Avoid trigger foods
  • Stay hydrated
  • Eat what sounds good, within reason. Snow cones are great as a treat, but they aren’t a replacement for protein. Try substituting the snow cone for a protein packed smoothie with extra ice. Craving something really strange? You might want to stay clear of things that aren’t really foods at all (like laundry detergent or dirt). This kind of craving is called pica, and usually means you are missing a key nutrient in your diet, so talk to your care provider if you find yourself thinking that your garden looks mighty tasty and you’re not talking about the vegetables.
  • Avoid yucky smells and have something pleasant to smell within whiffing distance. Essential oils can be great, but do take into consideration that some essential oils are NOT safe in the first trimester, or not at all during pregnancy. Please use them safely and wisely.

Other things to try:

  • Eat before you get out of bed
  • Take your prenatal vitamin with your biggest meal (and you can substitute your prenatal with a children’s vitamin – just talk to your care provider about which ones and how many to take)!
  • Acupressure: This is the one with *out* the needles. There are a couple of places where acupressure can be applied to help combat nausea. In 1988 study from The Journal of the Royal Society of Medicine, Professor John Dundee showed that the women who used acupressure in his trial suffered significantly less nausea and vomiting than those who didn’t. There is one on your wrist, the P6 point, and another million dollar point I’ll be happy to show you during our prenatal visit or childbirth class :-)
  • Sea Bands® specifically target the the P6 (or Nei-Kuan) point on each wrist using a plastic stud.
  • Ginger: You can have ginger tea, fresh ginger in your food, ginger cookies, crystallized ginger, ginger mints or suckers. Whatever you want to try! They also have ginger capsules, but I’ve read somewhere not to exceed more than 1000mg a day.
  • itamin B-6: A study done by Mario Festin on Nausea and Vomiting in early pregnancy, suggests that the Vitamin B-6 may provide relief. Please talk to your provider before starting, and get proper dosage amounts. Some say not to take more than 25mg a day, some say to take 25mg three times a day, and some say that over 100mg a day can lead to nerve damage. So just don’t start popping pills please!
  • Try candies, gums and lozenges to help minimize the metallic taste in your mouth, and help mask the excess saliva. Preggie Pops and drops are pretty great, (and you can get them in ginger too). I received some free samples from them a couple of years ago, and my boys were convinced that you had to be pregnant to eat them, and I didn’t exactly tell them contrary.

Having trouble brushing your teeth? Try a homemade toothpaste instead. A simple recipe of coconut oil, baking soda, and an essential oil of peppermint or spearmint might be just as good for you, and reduce the foam going on in your mouth (which can make me queasy I know).If you find yourself not keeping anything down, please talk to your provider about it. Hyperemesis gravidarum is no joke, and you might need some medical help to get through it.

 

For more reading: I found this research and thought it was a great read
http /www.motherisk.org/documents/BSRC_morning_sickness_EN.pdf while doing some

Medical Disclaimer:

The information on this website and blog is meant for basic informational purposes only. It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their health.