Saturday, September 10, 2016

Birth Thoughts, Part 3: C's birth- Emotional Signposts as Reliable Markers of Progress

My third birth this year was with a repeat client, which is extra fun.  I had served "C" and her husband during their son's birth 2.5 years before, and she had rocked a natural hospital birth, surprising everyone (including me!) with how calm and controlled she stayed throughout transition.   We were all a bit shocked when she said she thought she was ready to push (she was!).  This second birth was in many ways the same...

Well, we did have some drama early on when Miss M's heart rate dropped through the floor, getting us admitted faster than I've ever seen.  Baby M must have had her umbilical cord caught between some body part, because she really didn't like certain positions, and she definitely didn't like C's body's efforts to shift her through quicker, stronger contractions.  A terbutaline shot to slow contractions and some rest were enough to give M the time she needed to move on her own sweet time.  After the shot wore off we were able to move fairly freely, though C stayed on the monitor in case baby M's heart rate dipped again.

True to form, C labored so calmly and quickly as she progressed that baby M was almost born in the shower instead of the tub her mama had envisioned.  (I will refrain from commenting on the arbitrary policy of denying a mom entry into a labor tub before 6 cm, except to point out that moms are regularly given epidurals before 6 cm, and an epidural is far harder to reverse than a tub.  All you have to do if a tub gets in the way of labor progress is get out.)  However, this time I was not caught by surprise, not because C was having regular cervical checks, but because I was watching her emotions.

C's birth left me with a clear example of how emotions/moods are a reliable marker of labor "progress."  I remember learning about this in the Bradley birth class I took while expecting Eowyn, and it was mentioned again in my Hypnobabies birth class.  I'd seen the various phases in other births, but never so clearly as C's birth, possibly because I knew I'd need to watch for them if I was to not be caught off-guard again.  With this birth, I learned that emotions really are more reliable than contraction length or strength, and especially the clock, when it comes to discerning how close a mama is to giving birth.

1. Excited phase- when we got the hospital, C was having contractions that were quite strong, yet in between them she was excited, joking with me and her husband about the baby's name, thrilled with "eating" popsicles, able to relax and rest.  Despite the length of time we spent in this emotional phase, I wasn't surprised when the nurse checked C and found she hadn't dilated much; emotionally she just didn't seem to have "moved" to me.  However, within 15 minutes of being checked, it seemed to me something shifted, labor wise.  C wanted to get into the tub, and being told "she wasn't dilated enough," she opted for the shower.  Her whole demeanor became purposeful, she got very quiet between contractions, and I could tell she had moved to the next "phase:"

2. Serious "get her done" phase- once we moved into the shower, C became far more vocal about what worked or didn't work for her, with my suggestions being either followed or met with a clear "no, I don't WANT to."  (This had her husband laughing because C is usually the most soft-spoken compliant person ever.)  She no longer wanted to make any decisions but also knew pretty quickly when something wasn't working for her.  We worked to get the hot water hitting various parts of her back, and provided hip counter pressure.  I called the nurse and asked again for a tub, explaining that with her previous birth, once we had hit this point, birth was fairly eminent and we wouldn't have much time to set the tub up.  The nurse seemed torn, but had been told by the OB that she should leave C to labor for a while longer before checking her, and that there was no way she had dilated much in the past half-hour after her long slow labor of the morning.  But she agreed to come back after she checked her other patient.  Within a very short amount of time C's emotions changed again.

3. Vulnerable phase- This was accompanied by a loss of modesty and a need for reassurance. "I'm not sure I can do this" was heard as well as "Oh, this is hard."  When C, a hospital nurse herself, was willing to go on her hands & needs in a hospital shower, I knew all inhibitions were gone and pushing would be soon.  I kept up the encouragement and so did C's husband (it wasn't hard because C was so beautiful as she labored!).  Within 10 minutes, I could tell that C was bearing down a little with each contraction and we moved to the bed (earlier she had said "I don't want my baby born in the shower!") and I called the nurse, who hadn't made it back yet from checking on her other patient.

4. Energized phase-- I call this the "mama dinosaur" phase- C never got to a certified "roar," but she definitely FELT like she was loud.  We called the OB in who was so surprised that the labor had gone so quickly all of a sudden.  To her credit, the OB was calm and let C do her thing without trying to make her get in any particular position.  Her earlier doubts gone, C pushed efficiently and effectively.  In a very short amount of time, baby M was born!  Once again, C had rocked a birth so calmly and quietly that the staff was caught off-guard!  I would have been, too, if I hadn't been with her the whole time and been tuned in to her emotional changes.  It helped that I'd been at her previous birth and knew how she was in birth -- another plus of having a care provider who stays with you during most/all of the birth (such as a midwife), and of having support that is consistent across multiple births!  

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