Thursday, August 13, 2009

"Natural Childbirth?!" "Are You Crazy?!" Apparently So

Warning: The majority of this blog is educational and not as fun as some of the others I've posted

“Who is planning on getting an epidural?” asks the childbirth class instructor. Of about twelve, all but three couples raise their hands. Jon and I are included in these three.

I’ve been asked by my friends, family, and even complete strangers whether or not I will be using “drugs” during labor and delivery. At first my reply was a firm “No, I’ve decided to have a natural birth.” These are the responses I have gotten:
“Just wait, you will be screaming for that epidural!”
“Things may not go as planned and you may not have a choice.”
“Don’t have your heart set on it, you never know what’s going to happen!”
I have even gotten the “oh but honey, you are too small” speech
Needless to say, support has been minimal. Generally I smile and nod in agreement. I have found that changing my answer to “Hopefully, I will be able to have a natural birth” or “I would like to try a natural birth” gets a better response. I don’t go into all the reasons why I have chosen to have a natural birth. Most people don’t want to hear it. So, stop here if that’s you!
In my first trimester Jon and I were told to watch the documentary, “The Business of Being Born.” It compares and contrasts natural birth at home and medically assisted birth in a hospital. It offers a glimpse into a world of childbirth that I for one had never seen. And as you probably guessed, it favors natural childbirth and the at home childbirth experience. I suggest this documentary to anyone who plans to have children. Even if you don’t agree with their ideas it never hurts to educate yourself on alternative methods of childbirth. It changed mine and my husband’s feelings greatly.
It seems that there are numerous ways to give birth, all of them very different but none necessarily better than the other. It really depends on what you are most comfortable with. In the US the most popular way to give birth is in a hospital under the care of an obstetrician and nursing staff. The second is again in a hospital but under the care of a midwife. The third most popular is giving birth with the help of a midwife in a birthing center and the fourth is doing so, again with a midwife, in your own home.
Many people say that giving birth in a hospital is the safest way to go incase complications arise. Others choose to do so, so that they can receive an epidural or other drugs. In most cases, a birthing center is not equipped to administer most systemic or regional anesthetics and in the case of an emergency an ambulance must be called to take you to a hospital. The argument in favor of the birthing center and/or at home delivery is that the birthing experience is more pleasurable. Also it is viewed that an obstetrician, who is a surgeon, is not needed in normal labor and delivery. In a birthing center or at home, your experience is completely up to you whereas a hospital may have policies about things such as IVs, water births, who can attend the birth, who can “catch” the baby, what you can eat during labor, and etc. However, it is important to note that these policies are put into place to protect you and your baby.
Jon and I have chosen to have our baby under the care of my obstetrician/gynecologist in a hospital. I have never given birth before and feel that I will be more relaxed in a setting that is equipped to handle complications should they arise. That said I probably would have opted for a midwife if my doctor’s office had one on staff. I think using a midwife in a hospital is ideal because you have someone more geared toward natural delivery but if need be a doctor can step in at any time.
I have done a lot of research on the assistance of medications and anesthetics during childbirth as forms of pain management. After a lot of consideration we have chosen to make the experience as natural as we can within the walls of a hospital. In our minds the disadvantages outweigh the advantages of medicinal intervention and we would prefer to steer clear of the problems that can arise out of medications and anesthesia.
I have found that there are seven types of drugs that can be used when it comes to managing your pain during childbirth. They are under two categories; systemic medications and regional anesthesia. Each has advantages and disadvantages.
Systemic medications include narcotics, tranquilizers, and sedatives. They are given orally or intravenously and affect your whole body. They can also affect your baby and must be given at the appropriate time with an appropriate dose depending on the progression of labor. These medications include; Demerol, Nubain, Stadol, Phenergan, Vistaril, and Seconal. Advantages of these include; increase of pain tolerance, increase in ability to relax, decreased anxiety, alleviate nausea, and may be used to stop false labor. Disadvantages include; sedation, drowsiness, decrease or increase in speed of labor, respiratory and neurological problems in the baby, and they offer relatively no pain relief.
Regional anesthetics are administered to the lower part of the back or into the lower birth canal. They block nerve impulses that transmit pain. They include local anesthetics, pudendal block, epidural, and spinal epidural. Each is administered through injection or intravenous line. Pudendal block is administered by an injection into the vaginal wall and is used when forceps are needed or during an episiotomy. A spinal epidural is used when a cesarean is necessary. Advantages include; pain relief with no sedation, little effect to baby, and increase in ability to relax. Disadvantages include; not effective in some patients (15%), does not necessarily block discomfort of contractions, may decrease mother’s blood pressure, decreases ability to push, may prolong labor, confinement to bed, and rare nerve damage. Other side effects of epidurals include headache after delivery, loss of consciousness if needle is misplaced, and toxic reaction. However, epidural anesthesia is the most common use of medical pain management and is considered safe and excellent for those women who require considerable pain relief during labor.
The alternative to medical pain management is natural labor. Coping mechanisms for pain include relaxation techniques. Body awareness, distraction, slow and paced breathing, massage, meditations, guided imagery, and water/warmth remedy are combined to help manage pain. The advantage of natural labor is clear. You don’t risk the problems associated with medicinal intervention and you are in control of your own body. The mother can feel when to push, she is alert and mobile, at birth the baby is more alert and latches more easily to the breast, and there is no need to reverse or wait out the effects of anesthesia. If you have pain medication during labor, after it has worn off you will be just as sore as the woman who had a natural birth. There are of course disadvantages to natural labor. These include; exhaustion due to pain which can prolong labor, emergency anesthesia if a complication arises and there is need to perform a cesarean or use forceps, and possible dehydration if an IV isn’t administered.
With all of this knowledge and more we really want to have a natural childbirth experience. I like to think that our views are balanced. We understand and respect the arguments and issues of both sides of the spectrum. Each woman’s pregnancy is different just as each childbirth experience is and there is no right or wrong as long as the baby’s and the mother’s best interests are at heart. But here are the facts and our personal reasons for choosing the way we have. Maybe I should print this out and carry it with me. Each time I’m asked whether we are getting drugs or not I could just hand this out.
: o)

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