Childbirth. What's up with that?
May 14, 2014 2:31 PM   Subscribe

Next in the string of Major Life Events: getting this kid out of me. I feel like most of the resources out there (including the classes I was looking to for advice) are pitched toward people who have already decided whether or not to have a natural, unmedicated childbirth, especially here in granola-land. I don't know; I want the baby out and safe, but I don't care about being SuperMom; I am pretty sure there's no reason to be in pain if I don't have to be. I just want to be able to get through it and be with my husband and baby. Thoughts, experiences, advice?

What kind of language can I use in talking to my providers about what I want? What are the sort of steps and benchmarks of what I can choose?

I'm in the USA, will be close to 35, first timer, currently 27.5 weeks pregnant. (Due August 11.) Husband = awesome partner.
Plans are to give birth at our well-regarded hospital birthing center, where my OB may or may not be available (they have a rotating team). The birthing suite has a nice Jacuzzi and a yoga ball. I will probably get a doula, but I haven't met one yet. The hospital says outside people are welcome to come in -- massage, probably acupuncture, even aromatherapy (they've had someone in the past).
I am overweight and have had low back pain all my life, but otherwise the baby side of the pregnancy has been very healthy. Doing prenatal Pilates. No gestational diabetes. Did test positive for Group B Strep, though.

Also, I have ADD and recurring anxiety and am not great at focusing, meditation, whatever.

Pain tolerance:
I have had surgery in the past (broken elbow) and do pretty well with anesthesia if needed. I generally take pain medication only if absolutely necessary, but during pregnancy I have had reflux/back/pain/possible gallbladder issues that have only gone away with the use of Vicodin or hydrocodone (one pill). I have managed sitting around in pain by listening to long symphonies that distract me from thinking about how long I've been hurting.

KathrynT, that human research repository, tells me that one reason to go unmedicated is that the feedback loop between uterus and brain is one of the things that helps labor move along, and you want to wait until things are really galloping along before you start messing with that, or you can get into a kind of a crappy slow labor/pitocin/stressed baby situation. And things hurt *a lot* sometimes before they get really galloping along. What worked for her was managing labor without medication for as long as she was having contractions, but when the contractions started having HER... epi her up.

Thank you!
posted by Madamina to Health & Fitness (55 answers total) 36 users marked this as a favorite
Dr Jen Gunter wrote about this issue this week--I don't really know much about her bona fides and nothing at all about childbirth--but I find her writing appealing and her positions seem rational to me.
posted by crush-onastick at 2:34 PM on May 14, 2014 [1 favorite]

One thing I will stress is that while there may be sound medical reasons to delay an epidural, there are no moral reasons to delay an epidural. Labor progression not withstanding, you don't have to wait until you need it to get it -- you can get it when you want it.

Our hospital had jacuzzis and birth balls and doulas on call, and great C-section rates, and something like a 97% epidural rate. It's . . . really common.
posted by KathrynT at 2:43 PM on May 14, 2014 [20 favorites]

I really like the information in (and the tone of) the Expecting Better book - she has a chapter on this issue. The main reason she discusses for avoiding an epidural is that the mother's recovery after the birth may be faster without it (and the reason for getting one is, of course, effective pain relief). I think it's worth a read.
posted by insectosaurus at 2:44 PM on May 14, 2014 [6 favorites]

I worked in a hospital and I've been in labor rooms.

Don't let pressure from other people factor into your healthcare decisions. If you want that epidural, get it Don't think twice. This is between you, your partner and medical professionals.

You hear it all the time, don't let perfect be the enemy of good enough. We all want perfect when it comes to birthing babies, but it's not always the right answer. Do what's right for YOU and your baby, and you may not know what that is until you're in the middle of labor. The midwives, nurses and doctors are all on your side and want what's best for you. Don't suffer in pain, just for the sake of it. Ask for advice every step of the way.

Also, you want to be with your baby 24/7 right after birth. Let them take baby to the nursery so that you can sleep. I'm serious. Don't be hero there, you'll have plenty of baby and sleepless nights once you go home!

Mazel-Tov on your impending parenthood!
posted by Ruthless Bunny at 2:44 PM on May 14, 2014 [9 favorites]

What kind of language can I use in talking to my providers about what I want?

You've answered one of your own questions:

I want the baby out and safe, but I don't care about being SuperMom; I am pretty sure there's no reason to be in pain if I don't have to be.
posted by vitabellosi at 2:46 PM on May 14, 2014 [4 favorites]

I didn't have anything with my first kid, and I'm so ADD that I was distracted by the TV set in the birthing room and would forget to pant or whatever I was supposed to be doing, but he slid out after I pushed when they told me to, and the best part--a couple of hours later, I felt like I could climb Mt. Everest and have a three course dinner all at the same time. Endorphin rush!
And then, a few years later I had a scheduled C-section, and I was miserable for days, even weeks. But I had the baby, and that's what mattered.
So, giving birth is like a box of chocolates, only you know you're getting a baby, not the coconut cluster. You can do whatever you think is right, the kid might have plans of his/her own, and when the stars align, you all live happily ever after, except if they have colic and your milk won't come in. And then, later, they learn to drive.
Whatever you chose to do, you will be fine. Use your own words, tell the hospital, birthing center, midwife, Dr, nurse what you want, make sure your partner backs you up, and have a baby.
posted by Ideefixe at 2:52 PM on May 14, 2014 [7 favorites]

This is such a personal thing. Listen to what your body and mind are telling you, and do that.

I will say that I was a lot like you -- just get the baby out safe, that's all that matters -- for most of my pregnancy, but then the more reading I did, the more I decided that I really wanted to try for a low-intervention birth, and that it would be hard to do with the OBGYN and hospital I was working with. So I switched providers, and went to the crunchy end of the spectrum, but in retrospect I think the thing that really mattered, and that I didn't realize at the time, is that I really needed to TRUST MY PROVIDER and I did not trust that first provider to involve me in decision making. It was really less about interventions than it was about unnecessary interventions that I did not want.

With that first provider, I had a 2-page birth plan that was all about the interventions I didn't want. With the provider I ended up birthing with, I didn't have a birth plan at all because I didn't need one. We were a team and I trusted the expertise of my provider, and their commitment to involve me in any decisions that were made.

The nice thing about having a provider that you really trust is that you can talk about this stuff in broad strokes so he/she knows generally the kind of birth you want, and will make appropriate suggestions based on those wishes, but you can also trust that if things start going south they'll be able to suggest interventions and you'll know that they're really necessary, and not just for convenience. I personally think this type of experience is hard to get when you're working with an OBGYN/hospital because your provider might not be on call when you birth, and you might get someone you never met, and this is the whole reason for the birth plan is to mitigate the large institutional experience that most hospitals are. Birth centers can kind of go either way, they can be very hospital-like or very small and intimate, and I don't know which kind you have. The more staff you are able to meet and talk to, I think the better your chances are for feeling respected and heard throughout your labor and delivery.

So basically tl;dr make damn sure you trust your provider to be on the same page as you and to work with you rather than against you. (I changed providers at 35 weeks, it's never too late to do that if you have any doubts.)

Regarding pain: I am a total wuss when it comes to pain (and also ADD and have some anxiety). I never felt that I needed pain meds. Labor hurts, sure, but it's kind of a good pain. Pushing kind of feels awesome. It's like throwing up: practically involuntary, and such a relief. But everyone is different. So I think waiting and seeing how you handle it, rather than rushing into pain meds, is really the way to go.

Wishing you a happy and safe birth!
posted by rabbitrabbit at 3:01 PM on May 14, 2014 [7 favorites]

So hey lovely, you know that I lean way far crunchy side of things, and I'm happy to recommend books and resources along those lines if you want. Part of the reason I wanted to give birth at home was because I'm generally a wimp--much more than you are, from the sound of it--and I wanted to see if I could. I'd always feared the pain of childbirth and assumed I would have an epidural and I just . . . wanted to challenge myself. Wanting to go for an unmedicated birth is generally kind of looked down upon ("Don't be a hero--you won't get a medal!" is what I heard a lot) but it's possible and even, dare I say, not that bad.

I mean, it hurts a lot. That's undeniable. But unaugmented contractions (so that's taking stuff like pitocin out of the equation) go on for about a minute and then you get a rest in between. And you can stand just about anything for a minute, you know? That's one commercial break! And in between you feel fully in control of yourself and embodied. Late in my labor, I slept between contractions. And there are times during labor when things feel really really insurmountable, but those times mean you're generally making progress. For me, they were water breaking, transition, the last few pushes before baby gets out.

What was difficult for me is that, essentially, you have to go into the pain to get through it. And like I said, I'm a wimp. I avoid pain whenever possible. I take painkillers and whine a lot when I stub my toe. To do the unmedicated birth thing, you have to let yourself get swept along with it and trust that you'll meet yourself at the other side.

So, okay, why would anyone want to do that? Well, my experience was pretty close to Ideefixe's. The moment I pushed the baby out I felt totally. Fucking. High. It wasn't orgasmic--it was a really really good sensation all its own. In talking to my mother post-labor, I mentioned the awesomeness of it, and she had no idea what I was talking about. Because she'd had epidurals for both her births. Now, there's absolutely nothing wrong with an epidural. But it does mean you don't get that bright shiny moment which is physical (you will have other bright shiny moments, like meeting your kid). And afterwards was amazing. I gave birth at 4 pm and was up until about 10 that evening. I showered, ate a huge hamburger and milkshake (the best food I've ever tasted), wrote up my birth story, called my mom. When I slept, I slept really really well and deeply. The next day I was pretty exhausted, but I didn't find the baby's presence really onerous--perhaps because my husband took over all diaper duties for several days after but also probably because we were at home and not interrupted by nurses (all my friends who had hospital births complained about getting fragmented sleep because of that). Nursing often in the first days and nights after birth is good for milk production and skin to skin, if you can get it, is good for that, too. So just keep that in mind if you plan to breastfeed--you may not want to send your baby to the nursery. It's cool if you do, but there are benefits to chilling together that first night.

Of course, labor is always a roll of the dice. We don't choose to be low risk, and we don't always have a say in whether, say, we need an induction or not, which could make pain reduction more necessary. Hell, I had two friends plan for homebirths and end up with C-sections. I agree with rabbitrabbit that it's really important that you have a provider who you trust to steer you toward the best outcome for your situation. But just know that birthing unmedicated is pretty cool, if you're in a situation where it's safe and if you feel inclined to try it. And that comes from probably the biggest wimp in the universe, seriously.
posted by PhoBWanKenobi at 3:13 PM on May 14, 2014 [7 favorites]

I personally really liked being able to move around and get into whatever positions I needed to to get the baby out. After trying quite a few positions, alternating between the malasana yoga stance and standing up is what got the baby into the birth canal and crowning. For me. We tried the traditional laying on my back position that you see in TV and movies and whatnot and that slowed the labor down for us. With an epidural, you can't get into different positions to help get the baby out. And if, like me, being in that laying back position isn't what can get the baby out, then ... *shrug*

On the pain scale, for me, it was more all-encompassing muscles reacting than painful. Thankfully, I responded very well (like, from a 9 on the intensity scale to a 1 or 2) with my husband pushing his knuckles into my back for counter pressure. I only ever said "ow" when my calf cramped and when baby's head finally came out.

Everyone is different, though.

Other benefits to not having an IV include no artificial water weight for the baby to have to make up later (so much stress from new moms about getting the baby back to birth weight!) and no pain meds for you mean no pain meds for baby, which can mean a more wide awake baby immediately after birth.

I didn't feel like SuperMom after having a natural birth, but I definitely could see how moms can feel disempowered when they don't have control over pushing and positioning. That being said, a friend of mine who had a rough induced birth experience with her first felt very relieved after the scheduled c-section of her second.

This birth video is one I watched quite a few times leading up to my birth. (No naked parts, so I don't know why it is age-blocked. Just loud labor moans, really!) It helped me normalize what a mom in labor actually can be like (not the panicked mess on TV and movies) and helped me feel like I could do it. And I did!

I don't know if breastfeeding is a big priority for you or not. Make sure your attendees, nurses, and doctors all know what your stance is on this and how big of a priority it is for you, if it is important.

A good friend of mine had a long, rough labor and says she wished she had a doula who could help "steer the ship" when both she and her husband were exhausted out of their minds. So that sounds like a good step for you if you do that.

Good luck, mama! Congratulations! Remember, labor is only one (or two) days of your and your baby's life. You'll do great!
posted by jillithd at 3:14 PM on May 14, 2014 [1 favorite]

It's not only possible but wise to make a birth plan that calls for escalating pain management. You can say "when I am managing labour well I'd like this, when I managing labour more intensely I'd like these options available to me, and if I have had enough I'd like to be able to call for an epidural." It's also a great resource for your birthing partners to have, because they'll know what options you pre-cleared at moments you may not feel that communicative.

And, it's also perfectly sound to interview doulas on the basis not only of their labour coaching style but also their ability to advocate for you.
posted by DarlingBri at 3:16 PM on May 14, 2014 [9 favorites]

Every delivery is different. Every baby comes out in its own way. So while asking opinions is valuable, keep in mind that any universal opinion about how all babies Should be born flies in the face of the fact that what you think you may want for your own labor may not apply when the time comes. For anecdata: I went in knowing I wanted an epidural. I have almost no pain tolerance, and went into my pregnancy saying my ideal birth would be like they did them in the 50's: you go to the hospital, they knock you out, and when you wake up they hand you a baby and your hair is done. When my baby actually came, because of hospital issues beyond my control, I couldn't get an epidural until I was almost at 9 centimeters, and the truth is it turned out I might not have needed it if I hadn't had such strong back labor - I don't remember the contractions as being anywhere near as bad as the back pain that came with them. I also ended up needing a massive episiotomy to enable a forceps birth (because baby Did Not Want to come out and the only other option was surgery), and no matter how much I hear that a c-section is unnecessary and to be avoided at all costs, I still look at my recovery time vs. that of my friends who had c-sections with some envy for them.
posted by Mchelly at 3:20 PM on May 14, 2014

Oh yes, watch birth videos! As many of them as you can. I took a birth class where we watched a wide range of birth videos, including one of a woman undergoing more than 24 hours of wretched back labor. Even that looked really different than what you see on TV, and that's close to worst case scenario, in terms of unmedicated labor.
posted by PhoBWanKenobi at 3:22 PM on May 14, 2014

Oh, and Nthing that if you are able to, hire a doula who is on the same page as you with regards to pain management and interventions. Having someone there with experience who can tell you your options at a moment's notice, and help you advocate for them in the middle of the chaos, can be priceless. Most partners are too swept up in the experience to be much help in this department, no matter how clear your plan going in.
posted by Mchelly at 3:25 PM on May 14, 2014

I went into birthing with the same mindset- just get this baby out with both of us healthy. I'm glad I didn't have any aspirations about unmedicated birth because I ended up getting induced and so needed the epidural. As soon as the drugs started flowing I felt so much better and really wished I had "given in" sooner. You don't get any kind of extra special mom points for going unmedicated. My baby needed to be pulled out with forceps, so my experience was kind of extreme. Also, I was not prepared to be so bored. Labor was long and I couldn't even focus on the Star and US Weekly magazines I had with me, nothing good was on tv, and I hadn't prepared my go bag with any entertainment, so gather up some stuff to keep you entertained early and have it ready to go.

If you want to, send that baby off to the nursery for the night. That is one of the best pieces of advice I got. I felt super guilty doing it, but knowing what I know now, I would do that again in a heartbeat. I breastfed the kid until he was practically two, and he's healthily attached. There are so many things that can feel like if you do This One Thing Wrong you will ruin your kid forever, but it turns out that's not actually the case. I was never really into the concept of the birth experience being a big thing in my life before, it turned out that's good because it was a painful and boring experience overall. It was physically traumatic for me at the time, but in the end we both came out of it healthy and I'm still glad that's all I really cared about.
posted by banjo_and_the_pork at 3:27 PM on May 14, 2014 [5 favorites]

I think it's perfectly fine to go in with the plan you have (start off unmedicated and see how you do.). I do think there are advantages from a mobility standpoint to delaying an epidural, but if you get to a point that you need it, you need it.

With my first kid, I started off unmedicated and once I was 5-6 cm or so I realized that, forget the bouncy ball and the tub, all I really wanted to do was lie on my side and have Mr. A rub my back. So I got an epidural, which worked perfectly. I could still feel everything, just not so much, it was only in for a few hours, and I felt great afterward--had the baby at 5 AM and he and I were bright eyed and bushy tailed for the breastfeeding class at 10. I also participated in a conference call for work, which in retrospect was sort of nuts, but the point is, I felt good! So an epidural is not necessarily a barrier to an enjoyable or fulfilling birth experience.

With my second kid, I had to be induced for (good) medical reasons, the labor it took much longer and I got the epidural much earlier in the process because contractions on pitocin suck. So I had it for a good 22 hours and by the end I was really tired of my limited mobility and the fentanyl in the drip made me itch. But that was much more of an "inductions kind of suck" problem than an issue with the epidural.

Anyway, as long as you trust your medical providers, you have people to support you, and you don't REALLY REALLY want either option (which is OK) there's no reason you have to make a decision right now.
posted by The Elusive Architeuthis at 3:41 PM on May 14, 2014 [2 favorites]

I didn't read all the other answers but I'll throw my two cents in.

Two years ago when Baby Jungle was born I wanted as natural a birth as was feasible and that's what I told my midwife/OB team. After 36 hours of labor with no epidural they told me my baby was having a bit of trouble and I could wait and see or have a c section which they recommended because they were worried. I went with the c section because as good as a natural birth plan sounded I wanted a live baby* more than anything. I don't let my decision to have her sliced out bother me, natural childbirth is great, but at the end of the day the most important thing is a healthy baby. The c section didn't interfere with breastfeeding and I was up and walking the next morning so the recovery wasn't so bad.

*We have lost 3 babies due to being born too soon so my view of childbirth is colored by that.
posted by julie_of_the_jungle at 3:50 PM on May 14, 2014

Lots of great insight here. I didn't have all of the cool stuff that your hospital offers, but I will say one thing, when the contractions become more intense and more frequent, you can't appreciate anything happening around you except for trying to get through it. My mother had four of us and all four births were different for her.

My OB/GYN sent the anesthesiologist despite my protest because she noticed that I was in so much pain that I was sweating from every pore. They changed my dress and wiped me down. I had to have my labor induced, but regardless, my doctor said something that every pregnant mom should think about: "If you don't get something for the pain, you will not have the energy to push the baby out when the time comes. You don't want to pass out while giving birth. Take the epidural."

I still wish that there was another way, but in the end, it was better for the baby to come out without my working too hard. It's more important for her to take her first breath sooner than to wait until I can get through the pain and push her out.

Congratulations, by the way, everything will be perfect. Like many have said, let your body tell you what to do. Women have listened to their bodies way before doctors existed and populated this world with strong and healthy babies. Don't think so much. Enjoy the rest of your pregnancy and prepare for many days without sleep!
posted by Yellow at 3:55 PM on May 14, 2014 [3 favorites]

I had some mild complications with my first child (posterior, or face up, which is somewhat common), and it was before epidurals were a common practice. I went as long as I could and then they gave me some woozy stuff and I was close to a C-section, but then that relaxed me and she turned around and they made me push.

My son was induced because my water broke (pro tip: don't hang blinds in a whirlwind of nest-building a week before you are due). After many hours on pitocin, they gave me an epidural, and within 1/2 an hour, the nurse frantically took the bed apart (to make it into a stirrup bed) and called the doctor in. He was also sunny side up and turned around shortly before this (i.e. after the epidural but before the nurse came in and found out he was on his way RIGHT NOW).

In both cases, I think I was so tense that the meds and epidural relaxed me. So focus on what is relaxing and let your partner and a doula shelter you from external stressors.

The good news is: it probably won't be anywhere near as bad as you imagine it could be. The baby will come out, and you will be in a safe place with supportive and competent people around you.

Barring complications, decide with your partner ahead of time some keywords and/or non-vocal signs to indicate if you are in distress, or that you are okay and want to continue as you are. Stay upright and active as long as you feasibly can, even if it's sitting in a comfy chair. I found that being flat on my back had the physical and psychological effect of putting me at the mercy of whomever entered the room.

If someone looks at you and says, "do you want meds?" it's okay to say, "yes." Do not let any guilt from anyone enter into the equation. And if you want your baby with you afterward, that's okay too. I was really stressed when they took my son away and woke up at 4:00 a.m., feeling really lonely and wishing I could hold him. So decide that ahead of time as well, if you want your baby in the room with you or not. I was not getting any rest while I was thinking about him.

Also, when you go home, tell your partner not to allow visitors the first few days, at least. My son's father practically threw a party -- I had delivered at 11:00 at night, got released at 6 p.m. the next day, and not only was the neighbor there, he had invited several people over to show off what he had done. I had to retreat to my bedroom with my newborn to get away from all of the people in my house. You'll be tired and it's up to you and your partner to keep people away. If I had it to do all over again, I would say, "visiting hours are the 5th day at 2:00 p.m. and you can hold baby while I take a shower and then we will visit and you will leave."
posted by Marie Mon Dieu at 3:55 PM on May 14, 2014

I've had three kids.

Good delivery nurses will tell you that no matter your labor plan, your baby hasn't read it.

Be open to change and be be willing to roll with the punches and the advice of the labor staff.

Be open to medication. There is capital-T Truth in being able to rest during a stressful or exhausting labor and being open to pain relief so you can regain strength for the delivery.

Please don't be swayed in any way by anyone's story of they had this, they had that, they were nauseous, they felt like a superhero, so the moral is to always go all natural, to never go all natural, etc.

Every labor is different. It isn't a good idea to read birth stories and assume the same will happen to you. It won't.

My story: my first kid was all natural (no pain meds, nothing). Ouch but fine.

I certainly didn't feel like a warrior afterwards. I was exhausted.

Second kid, all natural and induced. A different ouch and after her, I felt also exhausted.

Kid 3, the plan was all natural but I needed an emergency "skin to in in 60 seconds" c-section where I was given a perfunctory epidural and as they opened me up I could feel a lot. A lot.

After that birth, I was up and walking around an hour later and felt great.

You will know when you're feeling the need for medication, if ever. Don't let anyone sway you otherwise.

And as to where the baby sleeps (with you versus nursery), I much sleep do you think you're going to get in the hospital? Not much.

Keep the baby with you. Otherwise, that could be one of those things you could regret not doing.
posted by kinetic at 4:09 PM on May 14, 2014 [2 favorites]

I will just say that any decision you make is going to be the right one for you and having a birthing plan is a great idea. Making your plan (and that's what you're doing) is a great way to reduce anxiety, codify your thoughts, and communicate your desires to the staff.

Best wishes, sleep now, etc.
posted by plinth at 4:15 PM on May 14, 2014

I haven't given birth myself, but I'm a doula, and I've seen a variety of births.

I think that your current attitude is an asset; it's nice to have a plan, but it's not great for that to be a capital-p Plan which Must Happen. You want to have the right birth for you, so you should have some idea of what you want (otherwise you may end up having someone else's idea of the right birth!), but being open to changes in plan is a very good thing. You don't know how labour will go for you, or how you'll feel in the moment. Maybe you will feel great, and decide not to have that epidural you planned for. Maybe you will feel terrible, and get the epidural you weren't planning for. Either way, the decision should not be loaded with significance, it should be about what's right for you in that moment.

I can't agree enough with rabbitrabbit that trusting your provider is of utmost importance. If you don't know who will be with you during the birth (ie, it'll be whoever's on call), then that's a great extra incentive to get a doula, so there will be someone there you do trust and who can speak up on your behalf if necessary. In choosing a doula, I think the most important things are for you and your partner to feel comfy with her on a personal level, and for her to be 100% behind your plan (whether that's all-natural or not-at-all-natural or see-how-I-feel) no matter whether your plan and her personal opinions match. In fact, your doula's personal opinions should, in an ideal world, never come up--it should be all about you and what you want!

For further reading, I'll second Expecting Better; Emily Oster really makes the research evidence accessible.
posted by snorkmaiden at 4:31 PM on May 14, 2014 [1 favorite]

Physically and pain-tolerance-wise you and I sound similar.

The conversation I had with my OB was that I wanted to try for a natural labor, but I wasn't about to try to be a hero. Her advice to me was, if you think you will end up asking for an epidural, ask for it sooner rather than later.

In her experience, she sees many women who labor for hours and days without epidural, and by the end they are so exhausted that they don't really have the strength anymore to push the baby out, and they end up in emergency c-section.

And then, that very situation happened to two of my friends, within a couple of months of my giving birth.

Now, I was in labor a full 24 hours before it started getting painful, but when it did (my LO was sunnyside up), it was painful enough that I started holding my breath during the contractions, and I ended up feeling woozy, and like my limbs were going to sleep. I was on the verge of hyperventilating. This was all in the car on the way to the hospital, less than a 30-minute drive. When we got to the hospital I had my eyes closed and my head cast down, and all I could respond to the nurses questions was a bare whisper "epidural".

(Because my water had already broken at that point, and I was aways from being fully dialated, they also administered pitocin.)

For all intents and purposes I slept for the next 12 hours, and then when I woke up I was fully dialated and it was time to push. Best labor ever.

So that's just one anecdote. I fully believe that if he hadn't been posterior facing I might have continued to labor without epidural, but who knows. You will know in the moment. Best outcome is a healthy mom and a healthy baby.

I think there is a lot to be said for natural labor, but I also maintain that if natural methods and remedies were effective for all, modern medicine would never have been invented.

I will also say, though, that I learned a lot from watching The Business of Being Born. It made me a more informed and better consumer of medicine in this case, and I felt like I understood everything that was happening and the decisions that my doctor was making, which kept me relaxed for the experience.
posted by vignettist at 4:33 PM on May 14, 2014 [2 favorites]

I don't feel like you clearly indicated what kind of pain tolerance you have but it seems like you are implying it is on the high-ish side?

I have a high pain tolerance. I turned down drugs with one or both pregnancies at the early stage of labor because I felt okay. By the time I wanted drugs, I was basically told "Shut up. It's too late." When my sister had her baby, she was bedridden for much of the pregnancy. I told her "Sis, you have pain tolerance like I have. When they offer you drugs, TAKE THEM. Do not wait until you feel like it is too much. Given you have been on bed rest, you can't get through this without them. Just take them as soon as they are offered."

So if your pain tolerance is on the high side, that might be something to keep in mind and talk to medical folks about before the due date: What is the hospital's policy on that? Is there a point past which they won't give you the meds? And understand what your options are in that regard.
posted by Michele in California at 4:33 PM on May 14, 2014

I agree with kinetic, I read a million birth stories and it didn't help me very much in anticipating how things would go, because no one else is me, and I experienced things in my own way.

I did make an effort not to get attached to any particular way of doing things beforehand, which was good because I ended up getting induced (Pitocin). The only hard and fast thing I wanted was not to go through almost the entirety of labor and then end up with a C section, because that seemed like the worst of both worlds, although oftentimes when that happens, you really have no choice in the matter. But for me, I did.

I did 12 hours on Pitocin first, and by that point I was in transition, feeling completely overwhelmed by the pain. They asked me about an epidural at that point and I decided that I would like one. By the time the anesthesiologist was actually available, though, it was about an hour later, and I was feeling like I needed to push (this was around >9cm). I also felt less panicked and overwhelmed, and like I wanted to move around and change positions a lot - probably because I had gotten past transition.

Anyway, I got the epidural, and that completely halted the process (seemingly). I could no longer feel the contractions whatsoever. It was a very bizarre sensation to go from one extreme to the other like that. However, I was still uncomfortable and amped up enough that I could not get any rest nor could I focus on any sort of entertainment like the TV. Spent about 2 hours like that, and then I started to feel the contractions again. By the time I was fully dilated, the contractions were PAINFUL despite the epidural. Unfortunately, pushing never felt good to me. In fact, the more I pushed, the worse I felt, which was only helpful in the sense that I knew the only way things would improve was when the baby was out. The epidural helped me avoid any sensation of my skin stretching or burning, but I still felt the deep pain and pressure.

I ended up pushing for about 4 hours, and I felt like part of the struggle was that I could not get out of bed due to the epidural, and to change positions I needed help from my doula and nurse because my legs were like sleeping logs. After 4 hours of pushing (including some decels in the heart rate and moments of concern) they started threatening me with a C section, and I feared the worst. At that point I just decided I had to go all out, use every shred of energy I had, forget all modesty, etc. I tried every crazy position I could get into regardless of how many nurses would be looking at me from what angles, and I yelled and pushed my hardest. And suddenly they stopped talking C section, started cheering me on, and started breaking down the bed. Not long after that, I had my daughter in my arms and nothing mattered anymore, and I went from screaming in the worst pain of my life to straight up laughing in joy within the space of 2 minutes.

The bottom line was, I was not opposed to meds or epidural whatsoever (after all, I'm a doctor myself), but I sort of wished I hadn't had the epidural in the end. Yes, I was in a lot of pain when I got the epidural and that took it away, but until I was pushing, I didn't feel like I was expending a lot of physical energy - just emotional energy. So getting to "rest" didn't help me, and it felt like it prolonged the process by a lot. I would have rather been done with the whole ordeal sooner. I was already hooked up to the IV for the Pitocin, and having to have a urinary catheter and be stuck in the bed really sucked. Once I had my baby, I felt pretty good and I wanted to hop out of bed and desperately wanted to take a shower and have breakfast, but they wouldn't allow that because my legs still weren't working right. Guess I don't know what it would have been like without one - hopefully I'll find out someday at another birth!

I recommend the doula. My husband's a doctor too and he seemed totally incapacitated in the heat of the moment to be able to help me through it. Doula provided sacral counter pressure that was fabulous pain relief during transition time. Wish I had found my doula sooner and had more time to chat and get comfortable with her prior to labor. I think you should look now. A lot of people reserve the good ones early.
posted by treehorn+bunny at 4:37 PM on May 14, 2014 [2 favorites]

If I could have guaranteed to have the labor and delivery I had with my second baby, I probably would have had a dozen more. I don't know if it was perfect timing on my part, my OB's part, or the anesthesiologist, but I got the epidural just when the contractions were seriously painful but I was far along enough re: dilation and effacement that it didn't slow down my labor. And then it started to wear off just when I started pushing. I could feel it all, the endorphins were spectacular, and it only took three pushes to finish the thing!

So I guess what I'm saying is listen to your body and trust yourself and those who are helping you.
posted by cooker girl at 4:47 PM on May 14, 2014 [1 favorite]

Data point: my wife's plan was "fuck birth plans." She got an epidural right away because it hurt. The labor progressed steadily and they had to give her more at one point because it started to hurt badly again. Then she pushed and pushed and she felt everything and the baby came! We feel incredibly lucky that nothing went wrong but on the other hand statistically what happened was the most likely scenario.

The only thing she regrets is bringing the baby right back to us and not getting any sleep that night.
posted by Potomac Avenue at 4:55 PM on May 14, 2014 [2 favorites]

Hey, I just did this four weeks ago. :) I had a similar mindset as you: wanted the baby out safely, was OK with pain meds. That was the extent of my "birth plan." I've had a series of life events that have *seriously* gone sideways on me, so I think that helped me roll with the punches when it came to childbirth.

So yeah, my only advice is just stay open to alternatives and ask questions, no matter how insignificant seeming. A lot of what I learned in childbirth classes was really helpful (breathing techniques are good to know!), and a lot of it I didn't get to use at all. Laboring on a yoga ball or in a tub? Yeah, sounded great in theory, but didn't get to use these since I went way overdue -- labor had to be induced and I was confined to a bed with a bunch of monitors strapped to me.

I ended up having to have an emergency c-section for a couple of reasons. I admit that was terrified going into the OR (never had major surgery before), but it ended up being really no big deal. I did not feel like a "failure" in any way, shape or form for not being able to give birth vaginally. This was the safest and smartest way for my baby to join the world, given what was going on with her and me, after hours and hours of labor.

Honestly, it sounds like you have a really healthy and realistic attitude, which will serve you well. Best of luck to you!
posted by medeine at 4:59 PM on May 14, 2014 [1 favorite]

I had back pain the entire pregnancy and when labour came, whaddyaknow, posterior labour and more back pain. Except it took me four hours (after being induced) to actually catch on that it was labour because it was indistinguishable from normal back pain. At which point I used gas and breathing.

One point that is important is how you deal with pain. I go silent, really really silent, and entirely internally focussed. Which meant, between that silence and contractions not being measured properly, the nurses didn't realise I was in second stage until they went to do their first dilation check and found a baby head. That, and the sleeping pills they gave me in the first stage because of it, impacted the birth more than anything else. I couldn't advocate at all for myself because of how I deal with pain.

(I did accidentally rip all the monitoring cords off because I couldn't stand to be on my back for another second and they kept telling me to stay still so they could get a reading)

(once I flipped onto my knees, I didn't move - it was much easier to deal with the pain because she finally rotated properly, then descended at speed).

As far as my providers, I told my Ob that the reason I wanted a natural birth was because it meant I didn't need any intervention - not because it was a goal.
posted by geek anachronism at 5:22 PM on May 14, 2014

Response by poster: This is all so great.

I am definitely the kind of person who likes to have a roadmap, just to let me know what's out there, but I am also comfortable with taking multiple routes to get to the destination. (Literally and metaphorically :P) So these are good stories to help me get an idea of where and when things could change.

One of the things my husband is good at is telling the providers about me when I don't have a great perspective. Like when we went to the hospital for back pain, I said, "I can breathe fine," but my husband said, "Uh, no, you were practically panting from the pain. You COULD breathe normally... but you didn't." So that's what I can focus on with a doula.

Doulas aren't ALL crunchy granola, right? They'll advocate for drugs when it's appropriate? I am definitely a "do intervention now so you have energy for later" person. (I also really want the doula to take care of my husband and give him a break.)

What are some good questions to ask when looking for doulas? I like that idea of sacral pressure -- any other skills that are really useful?
posted by Madamina at 5:28 PM on May 14, 2014

Was thinking more about this as I cooked dinner, and I have to say that one of the big things that helped me was understanding the stages of labor. Know that active labor is often long in first time moms. My midwives told me when we first met them that their biggest reason for transfer of first time moms was exhaustion because they often find it hard to sleep once their contractions kick in (they're excited!) True to form, when I had real, timeable contractions, they ordered me to get some sleep--and I actually did, about six hours all told! It wasn't the best sleep, but it definitely helped me prepare for the day to come. In my childbirth class, they told us to treat early labor like you're preparing for a marathon. So sleep, eat, and generally take care of yourself while you can. This is probably good advice regardless of pain relief.

(I know "sleep while you can" is grating advice while you're pregnant, but there you go.)

Also know that transition is the scariest and most physically difficult part of labor, usually. Pushing is grueling and it hurts, but nothing like the pain that just about gets you to 10 cm. My pushing experience was actually eerily like treehorn+bunny's--four hours, midwife was talking about an episiotomy so I rallied and pushed harder and pulled out all the stops. I kind of wonder if I wasn't pushing effectively earlier, but baby wankenobi had a surprise posterior presentation (I had back pain in the week up to labor, but not during it) so who knows. But anyway, transition is the suckiest part but it comes right before pushing which feels kind of productive and better, like you're in charge of your body again.

One thing I wish I'd done more of before birth was researching the mechanics of breastfeeding, so if you're planning on doing that, it might help. A friend of mine who gave birth a few weeks after me echoed that sentiment--that she kinda thought that after doing two really hard physical things, pregnancy and labor, she expected a break. But nope. Know that newborns want to suckle really really often, and this is normal and helps your milk come in. I found this and this really helpful.

As for doulas, their job is to advocate for you and your wishes. They're not all super duper crunchy. My friend who ended up with a Csection after planning a homebirth found her doula instrumental in helping make that decision.
posted by PhoBWanKenobi at 5:40 PM on May 14, 2014 [2 favorites]

Doulas aren't all crunchy granola, no. My doula had one baby in the hospital with an epidural, and one baby in a birth center without medication. I have considered becoming a high-risk doula -- a doula for women who know up front that they are giving birth in a hospital, who know that interventions are very much on the table, and who are there to advocate for the mother and help her negotiate a fraught and complicated process to a good outcome while feeling informed and empowered.

This isn't really what you were asking, but two questions I found really helpful to ask our doula were "Tell me about a birth where you were scared" and "tell me about a birth where you feel you really made a difference." Not just because you want to hear about her edge cases, but because you want to know what kinds of circumstances scare her, and what kinds of actions she is proud of. If her "birth where she really made a difference" is one where she screamed at the mother not to accept a C-section on a premature birth where labor had been going on ruptured waters for 2 days. . . that is something that may affect your decision making. I asked similar questions of my OB and my midwives.
posted by KathrynT at 5:42 PM on May 14, 2014 [4 favorites]

The only thing she regrets is bringing the baby right back to us and not getting any sleep that night.

Er she also wants me to point out that I should have said "bringing the baby back from the nursery instead of letting her sleep there while we got some rest after the birth." Instead of that weird thing I said.

Also happy 1 month birthday today to your kid also Medeine!
posted by Potomac Avenue at 5:43 PM on May 14, 2014

I had a bit of medication with two births, nothing at all with one. I liked having something to take the edge off. No epidural with any of them. So truth is there are many ways to approach labor and it's okay to be flexible.
posted by St. Alia of the Bunnies at 5:59 PM on May 14, 2014

I'm typing with my 3 month old sitting on my lap. For her birth, I knew I wanted an epidural. I did read up on that, but also non medicated births, because there's always the possibility that things go too fast or the epidural doesn't work properly. I had plans to labor at home when contractions started, to minimize hospital time. Except my water broke prior to any contractions (this was at 41 weeks); providers get antsy about the timeline after your water breaks due to infection risk, so off to the hospital we went. That was 7pm. Contractions started around 9. I hated the monitoring cords more than anything, as they were strapped around my stomach, which was all achey, and I really didn't want anything touching me. Around 2 I was still only at 2cm dilated, but was already feeling it enough that I wanted meds. I got IV meds so I could sleep. Since I had meds anyway, we added some pitocin to help move things along. Sometime after that, maybe 5 or so, I had the epidural. I felt fine at that point - just tired and bored. I slept more. It was 2pm before I was ready to push. At that point my epidural was wearing off. I could feel my toes, and I could lift my legs when I tried. I opted just to go with it, figuring that could help with pushing. I had 2.5 hours of pushing, and was very close to a vacuum delivery. There was a fair amount of pain and pressure, and pushing most certainly didn't feel good to me. Getting her out sure did, though! I walked to the bathroom about an hour afterwards, with assistance, and was fine the rest of the evening. My daughter was very alert and showed the appropriate latching behaviors.

Strangely enough, the pain was pretty bad in the moment, but it fades so fast. I'm kind of amazed that I got sent home with scripts for Tylenol 3 and Ibuprofen. You'd think you would need more.

Do check into your hospital's policies. Mine is "baby friendly," which means they have all of these things relating to breastfeeding and care that they do. The default is breastfeeding, no pacifiers, and no nursery. I was so exhausted that first night, that it asked them to keep her in the nursery, and they took her, but brought her back 45 minutes later because she seemed hungry. In retrospect I wish I'd sent her back again after feeding, but I just gave up and stayed awake with her most of the night. For an uncomplicated delivery, you can go home 24 hours after, so that's what we did. We had family staying with us, so our own built-in nursery of sorts. Definitely do that, if you can.
posted by bizzyb at 6:08 PM on May 14, 2014

Almost 5 years after an unmedicated childbirth, I haven't forgotten the pain! It doesn't "fade" for everyone. I think it depends on whether or not you chose to experience that pain.

Unmedicated childbirth hurts horrifically. And I say this as someone who has given birth to 2 children (now ages 6.5 and 4.5), and whose epidural worked beautifully the first time, but did not work the second time because my baby came too quickly. Giving birth to my second baby felt like absolute torture - and the kicker is it was suffering that was completely, 100% unnecessary. Gah! If I could do that one over again, I would have been induced at 40 weeks exactly and gotten the epidural straight away. This is advice pretty much no one in America ever tells you.

@vignettist already said what I was going to say: if you think you would like an epidural, ask for it sooner rather than later. Wait too long, it might not take the pain away. I, too, have known loads of women who labored for hours and days without pain relief, and by the end they were so exhausted that they had no more strength to push. They end up in emergency c-section, too. Not that this will happen to you, OP, but again, I think this type of narrative is one folks don't really talk about because maybe it feels like a personal failure (even though it's not!) when you have your heart set on going unmedicated. A good birth is any birth where mom and baby both leave the delivery room alive and feeling respected.
posted by hush at 6:17 PM on May 14, 2014 [3 favorites]

So, another experience for you. I was 36 with my first. I do not handle pain well and have through-the-roof anxiety about anything medical. Yeah, I'm a lot of fun. I asked my OB when the earliest was when I could have the epidural. She said "Um as soon as you walk in the door." So, I had modest contractions for a couple of hours at home, then they started getting closer so I went in to hospital. Got the relaxing drug (Nubain?) and we settled in, etc. Took about an hour and I went ahead and asked for epidural -- nothing excruciating, but my anxiety was building fast. Epi went in. Ahhh. relaxed. Kid showed up about 4 hours later. The hard part was pushing. Not terribly painful but it was exhausting and there seemed to be a lot of people yelling at me and telling me how to push. I never felt I was doing it right. But after a hasty episiotomy, out he came.

My 2nd kid was surreal. Again got the epi done early. I was asked if it felt strong enough. I didn't really know, so they bumped it up. I was so numb, I kept sliding down the bed so my feet were hanging off the edge. It was funny -- no torso muscles working to keep me in one position. Any way, fully dilated 2 hours in. Doctor checked me and her eyes got big and she ran to get gloves. She was then holding my daughter's crowning head with one hand while she got her other glove on using her teeth. Also fun. I innocently asked if I should push. She said "Oh no, she's right here." and she was...right there. No pushing.

My big take away was very little pain. The pushing wasn't pleasant, but I didn't want to get to panic mode from pain. And since I never had a birth plan, I never missed things not going according to a plan. Mostly I wanted pleasant memories and healthy kids. Lucky on both counts.
posted by bluemoonegg at 6:52 PM on May 14, 2014 [1 favorite]

I gave birth almost exactly a year ago (how will my tiny baby be a year old next week?????), and I think your plan to go in being open to all available options is a good idea.

I gave birth in a hospital with a midwife. The hospital had a birth plan form which lets you choose your preferences like using the birthing tub, if you want to be offered pain relief, and that sort of thing. I wanted to have an unmedicated birth, mostly to prove to myself that I could and because needles freak me out, so I ticked the boxes that said I didn't want pain medication, and I didn't want any offered to me while I was in labor.

My water ended up breaking at 2 a.m. when I was still awake because of having terrible heartburn. Contractions started an hour later, and my baby was born 12 hours after that. I didn't get any time to rest and was so, so exhausted by the time he was born. My first cervical check was off by 4cm--yes, really--and I probably would have been offered something to help me sleep if that had been correct, and my baby was a little off center, which made pushing less effective. I pushed for three hours, and about halfway through that I really wanted to ask for some pain meds but couldn't get the thought through to my mouth. My L&D nurse later told me she was impressed and surprised I labored so long and didn't have meds, and she was trying to honor my birth plan by not offering me any! Dang it! Hoisted by my own petard!

I was so exhausted that it was really hard for me to be present, and I didn't feel that sense of euphoria at all. Even after my baby was born I still felt kind of detached, and took a couple of days for us to get the hang of breastfeeding (though now he nurses like a champ!). All of the things that I was trying to avoid by not having medication ended up happening. Next time I will definitely be open to having pain relief.

It's really impossible to know what your labor is going to be like until you're doing it. It's really smart to not close yourself to options before you even have a chance to use them.

Finally, I don't know if you have read any of Ina May Gaskin's books--if you haven't, you should--but you should also read this blog post. The part where she talks about feeling like a failure because her birth didn't go like an Ina May birth? I totally felt like that too, and I don't want that for you or for anyone. And the part where she writes: “That shit is totally crazy and you don’t have to ‘handle it’ because the baby is coming no matter what and I’ll be there to hold your hand quietly or to let you scream and that’s okay. However you get through it is a victory and I am so proud of you, sister" is an important lesson to learn for birth and for mothering. Breastfeeding, sleep, food, stuff I haven't even got to's all some crazy shit, and however you get through it is the right way.
posted by apricot at 6:54 PM on May 14, 2014

Yeah, so I had two births on complete opposite ends of the spectrum for normal births for full term babies.

And this is my grain of wisdom:


So whatever keeps you safe and undamaged is what you should do. I got a ton of flack for choices I made for my second birth, but as someone who fully trusted a birth provider during my first to be horribly let down in the 25th hour, they were the decisions that I determined would leave me the least damaged.

A healthy amount of doubt in the labor room is not a bad thing. Doctors are human, too. And they are subject to making mistakes just like the rest of us. Just....theirs have greater consequences.

Do what you need to do for you so you can start your child's life in the best possible position. Your health and well being is critical, too. A healthy baby is NOT ALL that matters. Because you matter to that baby.

Don't forget that.
posted by zizzle at 8:06 PM on May 14, 2014 [12 favorites]

So much good advice upthread that I won't repeat it all again, but I did want to recommend Pregnancy, Childbirth and the Newborn. I think it does a good job of providing non-judgmental/presumptive information that applies across an array of birth options (different levels of medication and assistance in particular). I was able to use the relaxation techniques earlier in labor, although I ultimately went for an epidural.

Okay, I will repeat some of the advice from before: there's no shame in an epidural whatsoever, and get it BEFORE you really "need" it. And the part about saving your strength for the end is critical. You need to be able to work to push that baby out, and have reserves of energy if it turns into a must-come-out-NOW situation. Another benefit of the epidural is that if they have to do work on you after the birth (stitching up a tear or scraping out your uterus - fun times!) you're fully medicated for that stuff. Ask me how I know!

Also, definitely send your baby to the nursery between feedings, if you want to do so, and ask them to put a "do not disturb" sign on your door - which the doctors will ignore, but hopefully less critical interruptions will be held off for a few hours. Hospitals are not a restful place as there is round-the-clock activity, so protect your quiet time.

Also, while you're prepping for childbirth, also prep for breastfeeding. You'll need to shift right into that mode after delivery. But the mom/baby nurses are great resources for this - use their expertise, and seek help from the hospital's lactation consultants too.

Good luck!!
posted by handful of rain at 8:33 PM on May 14, 2014

*warning: this is humor, do not click if easily offended *

I just came across this humor piece about birth plans - if you showed this to your OB I think they would get a sense of what your preferences are and get a laugh out of it too….
posted by treehorn+bunny at 8:46 PM on May 14, 2014

Response by poster: Ha! I do know that my mom refused to let my brother be born to Rod Stewart, and the experience LITERALLY scarred her for life. Coincidence? I think not.
posted by Madamina at 9:02 PM on May 14, 2014

It's totally up to you and how you feel both before the birth and at the time of labour. After 2 children, the idea of a birthing plan amuses me. This is an ideal wish list. My sister clung to her birthing plan as a way of trying to control things, then when she needed up having a c section, she was upset as it wasn't on her plan. The key word for labour is flexibility. You can not control how it is going to go. Do not have a rigid view of how you think/ want things to go as I am 99% sure your plans won't work out.
I had a very slow labour with my son - 70 hours :-( As he was my first, I was adamant I wanted a natural birth. I was far too rigid and hard on myself. Only having gas and air for that amount of time made me tired and I was in real pain and I didn't conserve my energy for when I needed to push. By the time I was begging for an epidural, they said it was too late to give me one. The upshot was that he was born posterior and gave me second degree internal tears coming out (plus 2 episiotomies) so I needed to go into surgery immediately after having him. This was a bad outcome. Lots more paint labour, more mending required and I missed out on those first couple of hours with my child. Never again.
As it was, with my daughter, I had some complications and they had to induce me 2 weeks early. This time, as soon as they started the induction, I got hooked up to an epidural. This was awesome. I still felt pressure but it was totally manageable rather than real pain. I was watching tv until about an hour before she came out.
That's just my story. If I ever have a third, it would be epidural all the way but this is such a personal thing so you have to do what feels best for you and the exact situation you face when you go into labour.
Remember: flexibility, flexibility, flexibility. Good luck and enjoy bubba. Motherhood is awesome!
posted by ozem at 10:10 PM on May 14, 2014 [1 favorite]

Part of me wishes I had taken the epidural. I was induced in labour and told the nurses I would go naturally. They looked at me like I was crazy then I started breathing through contractions, nurse thought I was some hippie hypnobirther and would have made it without epidural.

Then the contractions started coming 1 min apart and hard with Pitocin cranked to the max. I started vomiting, which I thought was a sign the end was near. Unfortunately, at only 7 cm dilated with baby high, OB recommended section. And at that point - in pain, getting close to a breaking point, I consult with my doula. Do I continue, becoming exhausted, in the hopes baby would descend, or do I stop and take the section? I took the section.

Would taking an epidural have prevented the section? Maybe, but with my BP 150/100 and rising and with baby's meconium stained waters maybe not. Baby needed to come out. But in the moment where I chose the c-section, the increasing pain and lack of pain control definitely tipped me toward the section.

And yeah, taking a section for "failure to descend" with CPD as explanation is a fail in hippie medicine. Then I broke my pelvis and got some feedback that hey, my pelvis really is rather narrow and kinda brittle, and I probably would have been sectioned in any scenario.

So it's all a bunch of hand wringing over a done deal that I never realized was the ultimate outcome in the first place. I don't know how you write a birth plan for this. Just roll with it.

The guilt went away by school age, when all evidence showed my child as just lovely and developing normally. Any failure she has in life now will not be due to c-section, formula, or any other infant experience.

I will also point out that the insertion of an internal fetal monitor during a contraction was the most painful thing I have experienced in my life to date. If they want to monitor baby take the epidural.
posted by crazycanuck at 12:00 AM on May 15, 2014 [1 favorite]

I had an epidural. I don't regret it and it was absolutely the right thing for that labour - the baby's heart rate started doing worrying things, and would only settle and be picked up ok by the monitor if I lay flat in one position and did not move. The epidural let me lie still through contractions when nothing else in the universe would have done, and as a bonus, it let me be a bit more mentally present for discussions about options with the doctors and midwives when things kept going poorly, and I was really glad of that.

On the other hand, it also slowed down my contractions and gave me an epidural fever, neither of which helped matters re: mine and the baby's condition, and both of which contributed towards me and the doctor and midwives making the decision to go with an emergency c-section in the end. (The section was not a bad experience at all, and the baby and me were both fine.) The fever, plus the lack of feeling in my lower body from the epidural, also made me feel really out of it and detached from the whole experience in a way that I found really unpleasant. So there are potential downsides that aren't just about pain vs. no pain.

I don't regret getting the epidural, because it was the right decision for that birth. I'm glad I didn't make a decision about it beforehand either way, though - it's helped me when thinking about the birth since to know I made the decision that was best for those circumstances at that time, based on my own preferences. I would recommend having a birth plan and would definitely have one again if I gave birth again, not to set out exactly what I want to happen when, but to get my preferences and reasons for them clear in my head (and my husband's) ahead of time. One of the things in my plan, for example, was that I wanted to make all decisions about pain relief between contractions rather than during them so I could decide based on how I felt things were going overall, not just on how I felt in that moment - I got to do just that, which was great for me.

Other things I had control over which helped:

- staying mobile and upright as long as possible during labour - the pain went through the roof when they had me lie flat on my back.

- having been to antenatal classes that covered various interventions, how they worked and what the pros and cons were. (Example: knowing there would be a lot of people in the room during a c-section just as a matter of course - I think otherwise I'd have been really freaked out when they wheeled me in.)

- having the baby skin-to-skin as soon as possible, and asking for help to get breastfeeding started. I've been really lucky with breastfeeding going well, and I feel that having the baby latched on well and feeding shortly after we were out of theatre helped with that. Again, I'm glad this was in my birth plan, because I could remember "okay, I said here I wanted XYZ" when I was still so exhausted and feverish I am honestly not sure I'd have thought of it otherwise.

Finally, I second zizzle: you shouldn't feel like you don't matter. Pregnant women can be under a lot of pressure to say "I don't care about me, the only thing that matters is a healthy baby," and see having any kind of plans for or negative feelings after the birth as being naive and selfish. This is a really unfair thing we do to ourselves. You don't get extra Good Mother Points for not having feelings and opinions about what happens to you, any more than you get them for avoiding pain relief, and going in there feeling like you don't or shouldn't have any choice or control over what happens can set you up for a much, much tougher recovery emotionally. You matter too.
posted by Catseye at 2:15 AM on May 15, 2014 [2 favorites]

Then the contractions started coming 1 min apart and hard with Pitocin cranked to the max. I started vomiting, which I thought was a sign the end was near. Unfortunately, at only 7 cm dilated with baby high, OB recommended section. And at that point - in pain, getting close to a breaking point, I consult with my doula. Do I continue, becoming exhausted, in the hopes baby would descend, or do I stop and take the section? I took the section.

I think it's actually important to keep in mind that, as described above and mentioned by many posters, pitocin radically changes the experience of labor. Which isn't to say it isn't sometimes necessary (in fact, I had it after my baby was born to help me push out the placenta)! But it makes the prospect of childbirth without pain relief much more difficult, not only because it reduces the time between contractions but also because it increases their intensity. I've heard it described as one on top of another without a break. If I were getting an induction with pitocin, I'd get an epidural in a minute.
posted by PhoBWanKenobi at 6:55 AM on May 15, 2014

In re. labor

Two babies, two inductions because they declined to exit on their own. After preterm labor and bedrest with both, no less.

I think a good plan is, try without the epidural and see what happens. But be down with getting the epidural if you need it. If you get an induction, you are very likely to need the epidural. The first time, they broke my water before the epidural and it was like a wrecking ball to the head. I went from pain at a 1.5 to a 10 in about 30 seconds and nearly blacked out. The second time I got the epidural just before they broke my water and that was way better.

Talk to your OB about the anesthesiologists at your place. You don't get to choose when you go into labor (but I did!) and my OB actually consulted the anesthesiologist schedule when she scheduled the exact date of my second induction. This depends on your relationship with your OB, of course. I had two of the best epidurals ever. I don't think you really have a ton of control over it, but I did tell the anesthesiologist the second time around to go easy - I wasn't looking for pain obliteration, just to take the edge off. With the right epidural, you can feel and move your legs, you can feel contractions, and you can push. It just doesn't put you in blinding pain.

My first time around, if I hadn't had the epidural I probably would have ended up with labor + emergency c-section. I was just so damn tired by the end, I was falling asleep between pushes and if they hadn't done the episiotomy when they did, I don't know if I would have made it. I didn't have anything left in the tank and if I'd blown any more energy on surviving the pain? No way. Second time was way much easier. Woo stretched out birth canal!

Also: everybody worries about poop. You are going to poop when you are pushing the baby out. The nurses will cover/wipe it away quickly and discreetly. It will not be a big deal and nobody will care or be grossed out. If poop is coming out it means you are using the right muscles to push. Embrace the poop.
posted by telepanda at 7:46 AM on May 15, 2014 [4 favorites]

In re. delivery

I recommend asking to hold the baby right away when s/he comes out, and to breastfeed immediately. They can put the baby on your chest and do the wipedown and initial check there. It's pretty awesome. You do need to specifically request it though.

That said, it may not happen and you have to be ready for that too.
Here is something I wish I had been warned about: If there is meconium in the amniotic fluid, they will likely want to suction the baby as soon as it comes out. They will not encourage the baby to breathe until they have cleared its airways. THE BABY WILL NOT CRY FOR THE FIRST MINUTE OR SO.

This scared the everloving shit out of us when our son was born. He was delivered, there was a shout of "meconium!" and then dead silence as the baby was whisked away to the warmer and the circle of doctors closed around him and all we could see was a tiny bit of gray silent baby and that was the longest minute(?) of my entire life.

Then he screamed and pinked right up and his APGARs were fine and he's now a lovely 3 year old. Still gives me chills to think about it, though.
posted by telepanda at 7:59 AM on May 15, 2014

Oh, god, just get the epidural. Get it now.

mother of two
posted by The corpse in the library at 9:42 AM on May 15, 2014 [2 favorites]

OK, that was more flip than helpful. But when I look back on how I worried about birthing plans and what to bring to the hospital and all that... it was a waste of time.

I think relaxing is the most important thing. My first was a stressful (for me) birth, in a hospital that wasn't pleasant to be in, with a doctor I didn't like. My second was an easy-peasy delivery (things got a little weird afterwards but turned out fine), in a hospital that was friendly, with a doctor I like a lot.

I liked the yoga ball to sit on when I was pregnant, but it was useless during labor.

So I say do whatever it takes for you to relax.
posted by The corpse in the library at 9:58 AM on May 15, 2014

Re birthing plans:

With my first pregnancy, I was super sick and the pregnancy was really hard. I threw up for 8 months. I ended up severely anemic. At one point, I was sleeping 16 hours a day. They put me on megadoses of iron and it went down to like 10 hours a day of sleep. And I just never managed to make it to any of the free classes about how this was supposed to be done and all that. I felt like a failure and terrible mom and had guilt and yadda yadda.

Then I went into labor. The birth was really hard. Nothing could have prepared me for it. No amount of education or whatever would likely have made it noticeably easier. I very promptly got over all my guilt about not prepping better.

Sometimes, planning and all that makes a big difference. And sometimes it doesn't. I generally try to err on the side of researching and planning but, you know, the baby has kind of more say in when he/she wants to show up than you do. To some degree, becoming a mom is something that happens to you, not something you "do." That's part of what makes it so hard but understanding that helped make it easier on me, psychologically.

And congrats! Babies are nifty keen. :-)
posted by Michele in California at 11:14 AM on May 15, 2014 [1 favorite]

I just gave birth a month ago!

The person who said you need to save your strength for pushing is right. My epidural wore off during transition at 8cm, and the pain brought me to tears during the 5 minutes it was happening. My anesthesiologist was able to up the dosage and bring the pain down, but those 5 minutes are still the most painful thing I remember from labor.

Pushing is hard and physically taxing, and I'm not very athletic. I'm not sure how I would have been able to do it if I had been in agony for 7 straight hours before-hand.

My baby's birth was not traumatic, scary, or terribly painful. It was peaceful, and I'm glad our family of 3 will always have that memory.
posted by PuddleWonderful at 12:47 PM on May 15, 2014 [2 favorites]

So I don't have a lot of good advice on actual labor (having pretty much skipped that part myself) but:

I was set on as natural a birth as possible, mainly because I had a hope that this would lead to a quicker postpartum recovery, and partially because the video/animation of a c-section in my birthing class freaked me the hell out. Like tears and had to leave the class early, even though I'm not squeamish, etc. But may water broke 6 weeks early (surprise!) and five hours later I had a beautiful (behind his poor little cpap mask) and basically healthy baby boy via (medically necessary) c-section.

And the recovery was remarkably easy - despite a grueling round the clock pumping/NICU schedule where I was lucky to get more than two hours of sleep in a row. I was shocked at how quickly I recovered.

Now number two is due at the beginning of August (about the same time as you're due :) and now I'm more nervous about the possibility of a vaginal birth, so I'm debating a planned c-section vs. trying for VBA. Ironic.

When I talked to my doctor about waiting for labor to start (I think I read that this improves the baby's lung condition) before having a c-section, she said I could play it by ear if I want, wait for labor to start, see how things are going and go from there. So things can be flexible even on the extreme ends of intervention.

Also, I've ping ponged between two doctors and one nurse practitioner up until this point in my pregnancy (easy to do if you change your appointment times at the last minute : ), and ended up really liking the one that was just supposed to be filling in on a last minute appointment. There was nothing wrong with the other doctor but I didn't feel like she listened to me very well, so when she made a recommendation, I didn't feel very confident in it. In contrast the one I'm staying with is the opposite, I feel like she's understanding and directly responding to my concerns and so I trust her recommendations (it took her 2 minutes to convince me to get the first flu shot of my life). So nthing trust, on a gut level, of your medical person as seeming really valuable.

That being said, my understanding from my previous experience is that whether your actual dr/midwife is there when you actually go into labor can be something of the luck of the draw. So even if you trust that person, it's good to have back up plans in place (birth plan, husband, doula) to help navigate a possibly unexpected arrangement of events.

And I think if you want to play it by ear, without giving over control, then I think its important to (over) educating yourself (and your husband) now on what technical details of the different interventions. Be familiar with their pro's and con's, and identify any that are of particular concern to you in your birth plan and to your doctor, husband and doula, so you and your team will be better able to make those choices when everything starts happening. For example, I have weird low blood pressure issues so was concerned about an epidural causing a sudden drop in blood pressure. Being aware of this as a potential issue can help you better prepare for it just in case.

Okay, now I have to get off my butt and start working on my (re)education and birth plan number 2! Best wishes and congratulations!
posted by pennypiper at 2:12 PM on May 15, 2014

On doulas:

We are definitely not all crunchy! I work as a volunteer, not with paid clients, so I don't really get the "interview from the parents before we hire you" thing, but a question I might suggest would be "If I've decided to have an epidural, what would you do to assist me during the procedure?" Your over-crunchy doula might talk about how she will make sure you avoid the epidural, or possibly even talk you out of it at the last minute. A non-crunchy (or adaptable to your views, even if personally crunchy) doula should have some concrete ideas about how she would help you out with your epidural experience. (My answer would be: 1) check in with you and your partner to see if you have any questions for the anaesthesiologist, especially if they are being brusque; 2) make sure you definitely get up to pee one last time first!!!; 3) help you out with crunching up into epidural-receiving position, which can be tough if you're having hard contractions; 4) explain what's happening and what will probably happen next if the medical team is too busy to do that--for example, after epidural comes nurse with catheter.)

And for sure a doula is there for your partner too! To make sure he gets a break, to make sure he takes care of himself if it's a long labour (eats, sleeps, etc), and sometimes to say "nope, this isn't a good time for a break!" too. Or to take photos of the birth or deal with anything else extra that the two of you want, so he can be focused on you in the moment. When you're interviewing doulas, I would look for someone who spontaneously mentions that she's also there to support your partner. That's something I'm proactive about, not something I wait for the couple to request.

By the way, a book suggestion for your husband: The Birth Partner by Penny Simkin. It's a really thorough walkthrough with practical suggestions and colour coded pages; I take it to births with me.

If you have other questions/worries/wonderings about doulas, I'd be more than happy to chat via memail.
posted by snorkmaiden at 9:34 AM on May 16, 2014 [3 favorites]

Madamina, Just wanted to mention regarding epidurals that although I had also been told (by medical professionals) that it is best to wait until 5-6 cm dilation to get an epidural, if you want one, so you don't stall your labor and end up with pitocin or a C-section...

...I toughed out 36 hours of pretty heavy labor that only dilated me to *1 CENTIMETER* before getting an epidural. I had already been awake 16 hours when the labor started and so I had been awake and laboring 2 days with no dilation to show for it, and I absolutely NEEDED to sleep - my body was falling apart. My water broke spontaneously an hour after the epidural was placed and I was fully dilated just 3 hours after that. My midwife said that she has seen this pattern sometimes, and that for some women, the pelvic floor paradoxically relaxes better with an epidural in. (My baby was posterior until the very last minutes, maybe that was why.) For me, it turned out to be the right call, because I was utterly exhausted and needed the 90 minutes of sleep I managed to get before 2 hours of pushing.

So, even with epidurals, YMMV...
posted by Cygnet at 8:29 AM on May 20, 2014

Oh man, I just did this earlier this year, and I have so many thoughts. First of all, the birth classes - they are a lot of evasive and unhelpful handwaving. I got the best information by just asking my doctor to give me the 2 minute walk-through of what I could expect to happen. The hospital tour very much emphasized the fact that the labor rooms had bath tubs, you could use a birth ball, whatever, etc etc. - none of this was false, per se, but it was not exactly true either - they insisted on keeping me attached monitors, and I needed an IV because I, like you was GSB+, etc., so mobility was pretty limited to begin with.

Overall, prepare yourself that it's probably not going to go as planned, which if you are like me will be frustrating. I went in with as open a mind as possible - I was not opposed to an epidural but was not psyched about being confined to the bed, so I was just going to see how it went and do what seemed right, much as you are planning to do. I ended up needing Pitocin and an epidural, but in the end neither of those was a problem. Pitocin contraction are indeed, really really bad, so if you need it, just get the epidural and pat yourself on the back for not doing what I did and having to wait for the anesthesiologist to finish up like, 3 emergency C-sections on other women first while you scream in agony. And the meds to "take the edge off" are bullshit, just skip them and get the epidural if you want meds. For me, the contractions were nearly continuous on Pitocin, there were no "breaks" as with a more natural labor. I honestly don't know how I would have made it through the rest of labor without the epidural. The contractions were... completely overwhelming and exhausting and nonstop, so the epidural was really a lifesaver. Despite all these interventions, the baby was very alert at birth (appeared before me eyes wide open and wearing a serious "wtf" face), and we didn't have trouble making up her birth weight in the first weeks. I also had no trouble pushing - after about 36 hours of labor, I pushed her out in about 40 minutes, even with the epidural.

Part of what made my labor difficult was my (small) resistance to the interventions... I don't really know why, but I sort of had this idea that it would be better for it to happen naturally. Well, turns out the doctors were right, and I spent hours getting frustrated or in pain instead of accepting that Pitocin and the epidural would get me to where I wanted to be - with a healthy baby OUT.

Something that I didn't feel was well addressed was exactly how bad I was going to feel physically afterwards, and for how long. Perhaps I had a particularly bad experience, but I had a 2nd degree tear and things were really really painful for about 6 weeks. I could move around fine, but standing for long periods (like, to brush my teeth) was a no go. I was able to go on relatively short walks (about a mile, short for me..), but would then need the entire rest of the day to recover from them. The stitches would hurt if I slept with my legs drawn up (which is how I like to sleep). I think I felt pretty normal again by 10 weeks, but it was a long. time. I was taking percocets on and off for about 4 weeks and giant ibuprofens around the clock through about 8 weeks. And I sort of feel like no one really told me that's how it was going to be, so I spent quite a bit of time wondering if I was a huge wimp or something had gone horribly wrong.
posted by annie o at 9:51 PM on June 1, 2014

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