Saturday, March 28, 2009

Why take a childbirth class?

Call me a hypocrite. I’m a childbirth educator who has given birth six times and never taken a childbirth class. At least not as a pregnant person. I did have to observe some classes for my childbirth education diploma. If the truth be known, I wanted to take the hospital childbirth prep course when I was pregnant with my first baby. I hadn’t registered, and my husband wasn’t acting like he was going to have anything to do with it, but I certainly wanted to take them and probably would have. (Even if that meant going alone). If I remember correctly, the hospital wanted us to be 27-28 weeks when we started the class. I went into preterm labor at 22 weeks, and was in and out of the hospital and on strict bedrest for the duration of my pregnancy. Needless to say, I *couldn’t* take the classes. I read books on pregnancy and birth, but every time I thought or read about labor, I would start contracting! I was terrified. I was afraid that I wouldn’t even carry my baby to term (after all I couldn’t see myself as a mother, and I couldn’t picture it all in my head, so I thought it wouldn’t happen). I was afraid that if I DID get to term my baby would be deformed from all the medications I had taken to stop the labor.

In my Epidural post, I mentioned that they did not have Epidurals (at my local hospital) for laboring women when I was pregnant with my first. I was facing the unknown and I was living in fear. It would have been so nice to have a doula and a childbirth educator to help ease my fears and concerns. Not just with childbirth, but with the preterm labor stuff. I remember sometime around 32-33 weeks I was in the hospital, and it was looking like the labor wasn’t going to stop. I didn’t know what to expect of a baby at that gestational age... if it could cry, or if it would even “look” like a baby. The nurse did show take me to the nursery to see a 33 weeker. (My mother worked with the grandmother of the child, and they told us to go see the baby so I could see what my own baby would look like). The baby was perfect in every way. It LOOKED like a real baby. I don’t know what was going through my head, because I couldn’t accept that my baby would look anything close to that perfect baby. At times, I wasn’t sure my child was human at all! (Case in point, I was completely in shock seconds after I gave birth to her, because she was not only human, but beautiful and absolutely perfect).

My family was great. I did have lots of love and support from my husband and my family. I don’t think my daughter would be here today without them. But as wonderful as they were (and still are), they couldn’t help me understand what to expect in the delivery room. My mother had some of her babies under twilight sleep, gas, or spinals, so she couldn’t tell me what to expect. She did tell me (more than once) that women have been giving birth for thousands of years without drugs, and women give birth every day, and I could do it too. I don’t think I believed her. I was different. Heck, I was giving birth to an alien baby, so why should I believe anybody about the normalcy of birth? My niece sent me a wonderful letter. She told me not to worry and that she has just recently gotten a tattoo, and that hurt her much worse than when she gave birth to her daughter. I did find comfort in that. If I thought about a tattoo before that, I was certainly marking that off my list! My sister spent countless hours in long distance phone calls to me. She was a huge support person, but she was 2000 miles away. She gave birth twice without drugs, and had no doubt I could do it, but she was stronger than me. I was smaller, I was sure I couldn’t birth a baby bigger than 5 or 6 pounds. You get the picture. I was scared and I had no faith in my ability to give birth - especially vaginally.

Funny thing is that during this whole time of me fearing labor -I was contracting, and dilating and effacing! I remember a few weeks before my daughter was born, I was 4 cm and 90% effaced. My labor was half over before I even delivered. (I was 5 cm and 100% effaced the week prior to labor day).

Anyway, after her birth, I was overjoyed that I gave birth, and lived to tell about it. Not only that, I had a beautiful daughter with a thick head of dark hair rooming with me. I was so excited I could barely sleep that night!

So WHY do I feel childbirth classes are important? It’s certainly not my belief that women do not know how to birth their babies. They do! That is built into us. Our bodies know how, and they do it very well. Our brains, well, they can get in the way sometimes. But, even then, we are still very capable of having a wonderful birth. So, why do I still feel they are important?

During pregnancy we are faced with choices. Some may not even realize they *have* a choice. In either case, there are still choices every women makes. It might be her care provider, or the place of birth. It might be a procedure like pap smear or something more invasive like amniocentesis. We decide what we eat, and what we drink, and usually how we plan on parenting. (Things like breastfeeding, cloth or disposable diapers, to circumcise or not..etc) Some things we know are choices we are *free* to make, and sometimes we don’t realize we have any say in the matter. Especially if that decision has to do with something going on in the delivery room.

Do women have a choice in the way they give birth? Some things are obvious to most women, but not for everyone. For example, with my first, and even my second child, it did not occur to me that I could walk around during labor. I thought women went to the bed, and laid there for their labor. It did not occur to me that standing could make contractions feel ‘better’. I didn’t know I could walk around. After all I was attached to a machine and didn’t I have to have that on the whole time? It was not obvious to me!

You’d think I would understand something simple like getting out of bed - but nobody brought it up, and no one in my family knew anything about things like that - and the books I read obviously didn’t tell me these things either. (The one book said to relax, so I thought that meant lay down in bed). No, I would have to wait until child number 4 to understand many of ‘my choices’.

Now for someone like me (back then), it would have been extremely helpful to have taken a childbirth course.

So I’m sure you are asking: “Well, I’m pretty certain (or I KNOW) I’m going to have an epidural. Why should I take classes? “
If you take well rounded class, you will cover more than just basic childbirth. You’ll get some ideas on how to deal with pregnancy discomforts. You’ll learn about the various tests and procedures for pregnancy as well as during delivery. You’ll learn about what to expect where you are delivering, and get an idea of what will happen. How will you know if it’s real labor or false labor? Do you allow your doctor or midwife to break your water? If so, should it be done in early or late labor? Does it even matter? Would you rather tear or have an episiotomy? Do you have to have an IV? What is your option if you don’t want one? What constitutes an emergency, and how do you know if cesarean is really necessary? All of these things are nice to know before going into labor, and have nothing to do with pain control.

You’ll also learn a bit on what to expect after the birth. Women have lots of questions about this, but they still do not find it necessary to take a class that might explain it. Do you know what to look out for? What is serious enough that you need to call your doctor? What about the newborn baby? If this is your first baby, a newborn basic class is good too. Many childbirth classes talk about the newborn in one of their classes. You might learn about the tests and procedures they do on the baby, and what the results mean. You will learn what is normal, and when to call the doctor. You might know this stuff already - and if you do, skip that class if you want. I bet if you do go, you’ll still learn something you didn’t know! I know I did - even after baby number SIX!

Now what about unexpected things? If you read my blog on Epidurals, you will have read that there is a chance that your epidural will not work! Perhaps it will only work half way. Perhaps your anesthesiologist is not on call at your hospital, and you have to deal with labor for an extra hour longer than you think. Sometimes, labor just doesn’t go as planned. You might want to look into that back up plan: How to deal with labor naturally.

What if you have been in prodromal labor for a few weeks, and you have been slowly dilating and effacing (and if you don’t know these words, I suggest you take a childbirth class ;-), and you end up with a very fast and furious birth? What *IF* you end up giving birth before you get to the hospital? Yes, it is rare - but it does happen. I teach emergency childbirth in my classes, and I highly suggest that everyone look for a class that teaches some basic “how to’s”. Even if you have not been dilating, and effacing - you can still have that very rare - “I -gave- birth- in -two- hours -from- start- to- finish” births.

What about your partner? Wouldn’t it be nice if that person could learn what to expect? What is normal? What sounds you might make - (even if they are made before the epidural). How can that person help you cope? What can they do to make the contractions ‘better’? What about the very sights, sounds and smells of birth? Even if the mother has pain medication, your partner might want to see what birth looks like before your special day.

So is a childbirth class ‘worth it’?
Ask a bunch of your friends if they took childbirth classes, and if it ‘was worth it’. If they took a hospital childbirth course, you might find mixed reviews. Many will say “don’t bother”, and some will say “it was GREAT”. Ask another group about classes taken in a place OTHER than a hospital, and you will almost always get a positive review. Why? They most often have less couples per class, which means you can ask more questions. The instructor is up to date on all of the new research. Hospitals tend to use a nurse to teach classes, and they are not always up on the current research. They also tend to teach you how to be a “good patient” instead of letting you know you have certain options. Hospital childbirth classes tend to be more hit and miss. They don’t always talk about all of the things mentioned above. There are LOTS of really good hospital based childbirth classes out there. But you might have to ask around. With an out of hospital birth class, you are more likely to walk away a satisfied customer. Just do some ‘googling’ on childbirth classes. You’ll see what I mean. Hospitals: hit or miss. Private classes: almost always a really good review.

The types of classes I am referring to are “The Bradley Method”, “Birthing From Within”,” Lamaze” (and for some reason a hospital based lamaze class can be hit and miss too, so you still might be better off with an off hospital site class). There are more types of classes, and I’ll let you can find them. There are instructors, like myself, who are ‘independent’, who teach a little bit of everything - combining the best of all of the methods. Out of hospital childbirth classes are usually a bit more expensive. However, at least you know that your chances of wasting your money are a bit more slim. Like I said, most don’t regret taking this type of class. So the next time somebody says “don’t waste your money”, ask them where they took their class. If it was out of the hospital, just look for a different one :-)

More than likely, you will walk away feeling better about birth. I venture to say that most of the women out there who are saying “I’m getting an epidural”, are also afraid. They are afraid of the pain, to the point of - making sure that is what they get. Wouldn’t it be nice to at least walk in to the delivery room without as much fear? Even if you plan on an epidural, at least you know what you are asking for. You’ll understand it’s pros and cons, there won’t be any surprises should you have a side effect from it - and MOST OF ALL: You will walk in the birthing room with confidence. Give it a try, and if you want, comment on what your experience was like! I look forward to ‘hearing’ from you all :-)

Wednesday, March 18, 2009

Preterm labor:

This is a subject that I am quite familiar with, unfortunately. Let me give you quick definition: Preterm labor is defined as the start of labor between 20 and 37 weeks of pregnancy. (Before 20 weeks it's considered a miscarriage, and after 37 weeks, it is normal labor).
It will cause your cervix to dilate and efface. So - nothing to mess around with. I’ll give a quick run down of my experience and then we’ll talk about what preterm labor is, and how it is managed.

With my first baby, I had contractions starting at about 18 weeks. Since preterm labor isn’t managed until about 20 weeks, I was told to only come in if I was bleeding. I laid down and tried to stay hydrated. I had contractions quite frequently from then on, but I figured it was just normal. At 22 weeks, I was visiting with my niece (who had preterm labor with her first baby), and I was telling her about the tightenings I kept getting. She put her hand on my belly, and started timing those ‘tightenings’. She said “that’s a contraction, and they are 3 minutes apart”! She made me go to the hospital, and sure enough, I was already dilated 1cm and 80% effaced. The next 15 weeks was a rollercoaster ride with full bedrest (bathroom privileges only and a shower every other day, and it had to be a quick one!). We had several visits to the hospital when contractions would kick in despite the oral terbutaline. Those visits usually entailed a nice big dose of IV magnesium sulfate, and lots of prayer.

Let me give you an explanation of the two drugs mentioned above.
Terbutaline (brand names are Brethine, Bricanyl, or Brethaire): This drug is actually a bronchodilator (often used as a short-term asthma treatment). It works for preterm labor because it has a derivative of a hormone called epinephrine - which is released when we are under stress. (You know - the “fight or flight” hormone). Stress causes many of our muscles to contract so we can flee danger, and at the same time, it causes the smooth muscles to stop working until we are ‘safe’ again. Since the uterus is made up of smooth muscle, it relaxes. Meanwhile, the rest of you is in “freak out” mode :-)
Terbutaline can be given orally, by injection under the skin (called subcutaneous or sub-Q for short), and in some cases it can be given by a pump.

The most common side effects are:
* jitteriness
* increased heart rate
* tremors

Magnesium Sulfate: I think this stuff is evil. However, it may have kept my my first baby and possibly my second from being born too early. (I refused this stuff after my 4th pregnancy, as the oral terbutaline worked well if I took it every two hours)..

Mag/sulfate works in mysterious ways. Nobody really knows exactly why it works, but the common theory is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for muscle cells to contract, this is thought to relax the uterine muscle. Seeing as how they use calcium gluconate to reverse the effects of mag sulfate, it kinda makes sense.
It is also used for those who are having problems with pre-eclampsia because it lowers blood pressure and is an anticonvulsant as well.

It is evil because: First they start you off with a bolus. This can make you sweaty, nauseous, make you throw up and feel like you are going to die. Then they level off the dosage. You can’t see, (because you can’t get your eyes to focus), you can barely swallow, your blood pressure drops (so if you have low blood pressure like I do, that’s not fun). It can even make it hard to breathe. I won’t give you the ‘serious adverse’ side effects, just as I didn’t with the Terbutaline. I will tell you that they will take regular blood draws to make sure you don’t get toxic. Let me give you an example of toxic levels:

While pregnant with my first baby I was at the hospital during one of my many stays there, with my very enjoyable (heavy sarcasm) mag sulfate. I was talking a nap (what else to do when you can’t move, and focus your eyes to even watch tv). I woke up from my nap completely confused. I was *convinced* that we were being held prisoner and nobody could get in or out of the building. My husband was in the room with me, also taking a nap. I knew the hospital had changed our names. I started calling my husband by his new name (his name is Ron, but I was calling him Nori - which NOR is just Ron backwards lol). I called.“NORI”!.. NORI! ”, but he didn’t wake up. So than I decided to call him by his old name and I yelled “RON”!. I wanted to know if I was still pregnant, because they changed our names and whatever was wrong with me. I needed help to the bathroom to pee. He helped me in there, and I plopped down on the toilet. I became very upset, and started to cry because I didn’t know my name - old or new. I finally pulled the emergency cord because I needed answers. Two nurses came in running, probably quite frightened that I was giving birth on the toilet. I was crying and said “WHAT IS MY NAME”, “WHAT IS WRONG WITH ME?” The nurse turned my mag pump off. The helped in my bed and called lab up to draw my blood. Yeah, I was at toxic levels. I couldn’t have any more mag for the rest of the day and part of the night.

Another time, I had a much smaller reaction - when my mom came into the hospital to visit me. She woke me up and started talking to me. I couldn’t understand what she was saying. I kept saying “what?” and she would repeat it.. I would ask again to repeat what she was saying, but I couldn’t make sense of any of it. It was like the words were coming in randomly, and then lost the second they came to my ears. I don’t know how long this went on until either someone went and got a nurse, or somebody went to get her. I was in tears because I couldn’t understand the very simple sentence my mom was saying. The nurse thought my mom just made me cry, and put a ‘no visitor sign on the door’, but not long after, somebody realized I was not ‘with it’, and turned the mag off again. I’m just not a big fan of mag sulfate.

In case you are wondering about my other pregnancies the short version is this:
With baby #2, I started dilating and effacing at 28 weeks.. I spent the last 4 weeks dilated to 4cm and 100% effaced. Gave birth at 36 weeks (on the dot) (the day I went off bedrest and meds)
#3- I started dilating at 28 weeks (3cm 80%) - I was 4cm and 100% effaced from at least 34 weeks. gave birth at 35 weeks (zero days) (went to ‘partial bedrest that day, and stayed on meds, but had him anyway).
#4 - I started dilating at 28 weeks 6 days -(1cm 90% and stayed there) gave birth at 36w1day. (The day I went off meds and bedrest)
#5 - I started progesterone cream at 14 weeks (the kind you get at the health food store), my doctor laughed, but told me I could continue it anyway. I started dilating at 33 weeks 2 and 80% effaced). Was 5cm and 90-95% from 36 weeks on. This was my first child that I didn’t go into labor the day I went off bedrest or meds. I delivered him at 38 weeks and 2 days. (I used the progesterone cream until I was 34 weeks).
With #6 - At 33 weeks was 4cm and 80% - at 34 weeks I was 5cm and 90%. Went of bedrest and meds, on Friday, went to hospital Friday night at 11pm.. Gave birth @7am Saturday..the day I turned 37 weeks.

Signs of preterm labor: (Keep in mind you don't have to feel all of these symptoms!)

*Contractions (tightening of the uterus) at a rate of about 6 in an hour.
*Cramping and lower back pain - especially if it comes and goes every few minutes.
*Leaking amniotic fluid from your vagina.
*A feeling like something isn't right. It can be a burp that comes every 5 minutes, or just waves of nausea that come and go.. or pressure that feels like you have to have a bowel movement..

If you have been having contractions, your doctor will give a vaginal exam to see if those contractions have been causing you to dilate or efface. If you have been dilating and/or effacing - your doctor might do one of the following things:

1) The doctor may ask you if you have had any contractions in the last hour. If no - you might be sent home, even if you have begun to dilate and or/ efface. Your doctor might also do a fFn Test (Fetal Fibronectin) to see there is a chance your body will go into labor in the next two weeks. (Note:: Not 100% accurate - is not to be given AFTER a vaginal exam or recent sexual intercourse as it can cause wrong results)

2) Your doctor may hook you up to a monitor in the office, to see if you are having contractions. This usually takes about 20 minutes. If you are having contractions, you will be sent to labor and delivery at the hospital. If you have not had contractions in this time, the doctor may send you home. Perhaps with medication to stop contractions.

3) Your doctor may send up up to the hospital's labor and delivery and have you monitored there, and give you some IV fluids as well. If you are having contractions they will give you medications to stop the contractions. They may give you an antibiotic in case there is an infection somewhere causing the labor. They might give you a steroid shot to help mature the babies lungs. When labor has stopped, and the doc is comfortable with your status, you will be sent home with instructions to come back in if symptoms return.

If you think you are experiencing preterm labor, denial will not make it go away. The sooner you find out what is happening, the better the chances of it getting stopped. Yes, it is scary, but watching a baby fight to stay alive is *much* scarier.
To all of you mothers out there going through what I have been through: You are in my prayers. I wish you all the best!