Stalled labor, mental-health twist
February 19, 2021 2:39 PM   Subscribe

Person in question not medicated for their bipolar disorder because of pregnancy. Their mental health had deteriorated and induction was recommended. Started 36 hours ago. What do you know that can help me help them?

This person was dilated 1 cm when they went in and 36 hours later are still at 1 cm. They are saying things that people without mental illness say when they are in the middle of a long labor but this person also has had postpartum depression before and is in incredible distress.

I was able to help get this person some anti-anxiety medication and also some sleeping medication. The hospital where the person is has not called in a psychiatrist or anybody who knows about bipolar disorder. They told this person’s partner that they would call in a psychiatrist if things went too far, but they don’t know this person. The person’s partner and I know the pregnant woman well; things have already gone way too far for them.

It is nearly midnight in Sweden; what do you know that I don’t know that might help this person tomorrow morning if their labor is still stalled and no mental health pro called in? The pregnant person wants to avoid a caesarean and epidural, ideally; I’d like to avoid as much additional suffering as possible. This person also has health anxiety, and is probably worried about dying. I cannot be with this person; how can I help them?
posted by Bella Donna to Health & Fitness (10 answers total) 1 user marked this as a favorite
Ugh, I’m so sorry about this situation.

A couple of questions: does the person in labor have someone to advocate for her within the healthcare system?

Does the person in labor have a psychiatrist (even though she’s unmedicated)?

Can you and/or the partner make yourselves obnoxious until a psychiatrist is brought in? Can the partner or other advocate find out what the triggers would be for engaging a psychiatrist?
posted by chesty_a_arthur at 2:52 PM on February 19, 2021 [5 favorites]

Also, I hasten to add that these are questions because I know what I’d recommend in the US, but ...Sweden.
posted by chesty_a_arthur at 2:53 PM on February 19, 2021

Aside from the mental health issues, I would be thinking about what they could to get this (safely) over. Did they actually give her something to induce the labor? 36 hours seems like a long time to be stalled if they are actually giving her something that is supposed to be hurrying it along. My experience was that using pitocin to induce labor made the contractions much more painful and harder to manage. In my case, I was willing to use an epidural - once I got up to about 3 cm, they could it to me without stalling out the labor. Once it was in place, I was so exhausted I actually fell asleep. With the epidural they were also able to increase the level of pitocin so that it was only a few more hours until the baby was delivered. I don't know what is right for your friend but for me, the use of epidural was very positive to avoid total exhaustion that would in turn extend the labor even further.
posted by metahawk at 5:16 PM on February 19, 2021 [1 favorite]

yeah I took the epidural at about hour 24 when I had not dilated hardly at all, and promptly fell asleep for serval hours. was fully dilated upon awakening and proceeded to push. my doula was the one who advised it because she felt I needed to rest. can this be accomplished for your friend? sending good thoughts for a successful outcome, and I hope they have mental health care lined up for postpartum.
posted by Lawn Beaver at 5:21 PM on February 19, 2021 [2 favorites]

Is this their first delivery? It's possible that the first x hours were still intense prodromal labor -- I retroactively learned that this is what happened to me. From the pregnant person's perspective, the distinction may not matter because both hurt more than the pain (or lack thereof) that came before. But they might find it reassuring. My mom would have (she was all "you've been in labor HOW long?"). If the medical system is pushing unwanted pitocin on them, this might be a way to push back.

You know them and I don't, but my understanding is that anxiety (e.g., discomfort about who is in the room) can hinder labor. The more your person can feel safely tucked in a cozy animal den, the better. Also, the more in control, the better (anecdotal after listening to a lot of post-birth stories). Also, messages about their body knowing what it's doing might be helpful. Sometimes babies have to turn and it just takes forever, is my impression as a non medical person who had a long labor. Music helped me, as did back counterpressure. But there's a big psychological component. Basically, your body has to relax and open up to give birth. I think for me, the pain made me clench up and not want to go any further, so the eventual epidural made an immediate difference. (By my second birth, I sort of walked into the pain, knowing that "the only way out was through" and that "you can bear anything for 6 long breaths." But then again it might've just moved a lot faster for non psychological reasons.)

At some point they may want to make peace with pitocin plus the likely eventual escalation to an epidural. By that point, getting a little sleep would be helpful. But if they still have the stamina to keep going without it then I'd support them in that.

I started pit at like hour 50 and an epidural like 4 hours after that, if I recall. Went from not-very-dilated to fully dilated while getting a little sleep. Having had that sleep gave me energy I ended up really needing for the pushing phase and then the phase when the baby was finally here. I could still fully feel my legs and when to push; epidurals aren't all or nothing. That said, the just-before-pushing stage (if it goes slowly) can be a little panic-inducing, as you feel the baby moving but don't yet know how it will get out. Reassure your person that their body was made to transform this way and do amazing, powerful things.

Whatever you can do to help them feel they are in control and they are making the decisions and people are supporting them would be ideal. It's not obvious what the right decision is sometimes, so holding off from pitocin until they want to accelerate things, etc., can lead to the most peace of mind post birth. Feeling not-listened-to can lead to it being a traumatic experience (esp if on gas or something else that makes it hard to express one's wishes), and if they end up in a C-section, having been listened to will make it less like "if only they'd listened to me!!" anger and resentment etc. and more of "that's just what happened." (I had an almost-emergency that turned out fine but have avoided second guessing what happened because at every decision point, I got to choose and chose what I felt was the very best, more or less unavoidable (in my view) path, so it all felt very positive.)

None of what I write will be all that helpful as advice to your friend. See if the in room support person can make the room more comfortable, help your person breath through the contractions, and stand up for their right to make their own decisions.

Hope a little of this rambling is at all useful and best wishes to your person!
posted by slidell at 6:56 PM on February 19, 2021 [1 favorite]

The best way to push back against medical professional's pressure are questions like "do they need to decide right this minute?" "what are the other alternatives?" things like that. Their in-room person can create some space for your person to have more decision making power just by slowing down the rush to a decision (unless it's clearly an emergency).
posted by slidell at 7:03 PM on February 19, 2021 [1 favorite]

My wife was induced. nothing happened. Twelve hours later we got a new nurse, who said, "Induce all you like, nothing will happen until your water breaks." She did this- they have a special tool - and she was in hard labor in half an hour. Failing this, tell her to get up and move around. Hospital staff are not always knowledgeable, and they often keep the mother in bed when she needs to move around to get things going.
posted by AugustusCrunch at 8:42 PM on February 19, 2021 [2 favorites]

i'm not at all sure how these things work in sweden, but generally, in no way should you just be procuring what the asks for. i she has a patient advocate, get them involved - they can help with the psych consult.

and this maybe more of an ob/gyn thing - her mental health probably doesn't have a lot to do with getting the baby out, but not getting the baby out will affect her mental health. she may just have to face facts and agree to the cesaerean, unfortunately.
posted by megan_magnolia at 8:36 AM on February 20, 2021 [1 favorite]

As someone with mental health challenges who just gave birth, I feel for your friend. It’s possible that it will be nearly impossible for her to make decisions and advocate for herself until she gets into a better mental space.

Ironically, that might mean getting the epidural. I wasn’t planning on it and I had a lot of anxiety about it, but for me my labor progressed really fast and the pain was too much. After I got it I felt calm and while I still had pain, it was manageable. Can you talk her through what the epidural would entail and address her fears?

Alternatively, and this is going to sound weird, but if she is only at 1cm, can she leave the hospital and come back? Being in a calm space might help.

Does the hospital have a bathtub or shower for the laboring person? They would need to temporarily stop her pitocin and take her off the monitors for a bit, my doctor was okay with this and I stood in the shower for about an hour. They checked the baby’s heart with a Doppler a few times during this time. It helped me feel calmer.
posted by mai at 8:09 AM on February 21, 2021

I should add that I was in the shower before the epidural.
posted by mai at 8:10 AM on February 21, 2021

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