April #NewMoms group: "comfort measures in #childbirth"

 Sometimes "comfort measures in labor" feels like an oxymoron. Comfort in labor?! But with local birth and postpartum doula (& mom), Ashley Collins of Little Bee Birth Partner as our guide last Saturday at New Mamas group, we learned that there are things laboring moms and their partners can do to help offset labor pains. 

Ashley started us off talking about the importance of changing positions in labor. But as she said, "use them wisely,". Long lunges down the hallway, for example, might feel great in early labor but as labor progresses, that position will likely tire you quickly. It would be hard for a first time mom and partner to know that but this is where a birth doula like Ashley comes in. A birth doula is there specifically for support, ideas and resources...all for a woman in labor. She'll know when to suggest a new position and have other ideas in her doula bag too.

A couple other easy ideas that Ashley likes are:

• Get a head scratcher. I don't know about you but I LOVE having my head scratched! Ashley likes to use a head scratcher in early labor to relax moms.  
• Create a "birth cave"- Ashley likes to build one for laboring moms with Christmas lights as a way to soften the space of a hospital room as well as provide 
• Sweet & simple. A plain ol' sock stuffed with cheap rice is awesome for the lower back in back labor. Microwave to warm up, apply and mmmm....

Ashley is also a certified rebozo instructor and aficionado. The rebozo is a long piece of fabric that originated in Mexico. In labor, a rebozo can be used as an extension of a partner to support a woman in labor. (This brief video on Ashley's site offers a helpful introduction.) Partners want to help in labor and the rebozo is a nice way to "invite the partner" to support the mom in a truly involved way. 

Our new mamas on hand had a few tips too:

What a postpartum doula can do for you!

• Coconut water: I wish I'd thought of this one. Icy cold coconut water can be refreshing and way more interesting than plain water, ice chips or the popsicles usually on hand.
• Take a nap in early labor. A few moms said that they wished that they had napped to conserve some of their precious energy.
• Affirmations. Even if a birth plan goes awry or something unexpected happens, positive affirmations can be a wonderful way to stay focused and feel in control.

It was great having Ashley with us on Saturday! If you're a pregnant mom and are interested in learning more about how a doula can help in labor including with comfort measures, head to Babies R Us on Sunday April 26 for Doula Speed Dating presented by Bull City Doula Collective.

The second Saturday of each month is the free Outside The Mom Box support group for pregnant women and new moms with babies under 1 year. Each session starts with introductions and then goes in our main topic. We leave about 30 minutes at the end for Q&A. May's topic is: self-care.

To epidural or not to epidural?

When we see a woman in labor in television and in film, she is always in the second stage of labor, or what we normally think of as the pushing stage. [Side note to those unfamiliar: this is the shorter of the two stages but often the more suited to made-for-tv movies, hence it's popularity as The Depiction of what a woman in labor really looks like.] And no doubt this image of a woman working hard, seemingly in horrible pain, to birth her baby has contributed to the fear of childbirth that we have today.  That fear may be one reason why pregnant women can be so keen on getting an epidural.  Ah, an epidural....numbness from the waist down so you can't feel those dreaded contractions. Doesn't that sound fabulous? Maybe. Let's explore a few of the facts about epidurals:

1. Yes, epidurals can numb the laboring woman from the waist down and that can be a huge relief when you are tired and in pain. But what is less commonly known is that epidurals actually lengthen the pushing stage of labor...and by even more than what was originally thought. And a study published last month finds that epidurals are actually associated with a longer labor than had even previously been thought of and as if that wasn't enough, they may also lead to unnecessary interventions by doctors who worry that labor is going on too long.
2. Aside from longer labors, epidurals also prohibit the laboring woman from moving.  That in and of itself is problematic because we know that one of the best things a woman can do in labor is to move and change position. There are a plethora of reasons why it's important for a laboring woman to move but what might not be as obvious is that movement gives a feeling of control to a laboring woman.  It can feel very disempowering and even scary for a survivor of intimate partner violence or sexual assault to not be able to move on her own, and of course this applies to non-survivors too.
3. Epidurals numb the laboring woman, completely. Which means that a woman in labor don't feel the pain of contraction. Again, that can be a blessing but it should be understand that it can also add another wrinkle to your labor.  If you can't feel contractions then how will you know when to push? Yes, your partner or another support person can look at the monitor and see when you are contracting.  They can then urge you to ours at that point but ideally, you want to be following your body's urges to push (spontaneous pushing) as opposed to coached or directed pushing.  This is a great video on the benefits of spontaneous pushing, if that is not familiar.
4. Epidurals will numb the pain but not the pressure. That's an important distinction.  You will be feeling a lot of pressure in your perineum that won't go away until you actually birth your baby. That can be confusing for some first time moms because it basically feels as if you are trying to deliver a baby out of your rectum instead of vaginally! An epidural will not take the pressure away; it will only take the temporary pain of contractions away.
5. Epidurals aren't immediate.  From the time that you ask for one and the time that you are actually in position, an hour may have elapsed. An hour is what expecting parents (and me!) were told on our tour of The Birth Place at Duke Regional Hospital.  More information from that tour is here.  

Epidurals can be a wonderful coping tool for a laboring woman who is too tired and feels the need to recharge a bit from her long labor. But, like everything else, the pros and cons should be appropriately weighed before making a decision as to whether or not to have one. As with so many things in life, it's always better to be better informed in advance, during a childbirth education program for example, as opposed to having to make a decision in the moment.

Moms, did you have an epidural?  Or if you are pregnant, are you considering an epidural?  Leave a comment below.  Thank you for reading.

If you liked this post, please "click" the adorable heart below or subscribe here.

Touring The Birth Place at Duke Regional Hospital - Part I

A few weeks ago I had the opportunity to tour The Birth Place at Duke Regional Hospital.  Part of the requirement for my Lamaze Childbirth Educator program that I took through Duke AHEC was the completion of an education session and tour of a local hospital and since I delivered at Duke Hospital, I wasn't familiar with Duke Regional.  Imagine it: me and...25 other very pregnant couples. Between me not being pregnant and the fact that I asked a million questions, I stood out like a sore thumb!  But all in the name of offering good information to you, dear friend! So much that I'm going to divide this up into two posts.  This first one will deal with what happens up until you deliver your baby.  The next one will discuss what happens immediately after baby is born.

• If you think you're in labor, call your doctor/midwife/birth doula. They can help you figure out if you should go to the hospital or labor at home a bit longer.  If it is decided that you should head to the hospital, tell your doctor if you want a room with a bath.  There are 4 rooms with baths (the others have showers) at Duke Regional and they can fill quickly.  
• When you're on your way: head to the Emergency Room entrance.  Don't worry about parking.  You can leave your car there if need be and move it later.
• Once you're at the hospital, you likely will have a few things happen pretty quickly:
  • Cervical check.  Unfortunately, this seems pretty standard although it is not necessarily best practice.
  • An IV will be started and blood will be drawn.  We were told both steps were precautionary , in case you decide to do an epidural later was one reason given).  
  • You would also be hooked up to two monitors for a minimum of 20 minutes, to monitor contractions and also the baby's heartbeat.
• After this point, things can go in different directions-  
  • You might have continuous monitoring if there are risk factors present (vague I know but that's between you and your doc) or if there are medications involved.
  • Or you might have intermittent monitoring which would be every 30 minutes if you aren't pushing or every 10-15 minutes while pushing.
  • You might also be offered an IV pain narcotic such as Fentanyl or Stadol.
  • You might also see the anesthesiologist who will talk to you about an epidural.  Once that decision is made and after your blood tests come back, you can count on about 60 min from start to finish for this medical procedure.
• If you are having a C-section-
  • You will be given a spinal which will numb you from the neck down but you will be awake. If you have an emergency C-section (unplanned), you may need to be out completely but that isn't the norm.
  • It takes about 20 minutes to deliver your baby.  
  • Baby will go to the nursery for about 20 minutes then be returned to you.
• Duke Regional Hospital basics:
  • Labor and delivery rooms are private, small and some, as noted above, have tubs.  The others have showers.  Beds are adjustable. Lighting can be adjusted.  You can bring your own bedding, if you'd like. They have birth balls on hand.  Movement is encouraged.
  • Food tends to be limited in labor and while in the ed session we were told food would be available from the hospital cafeteria after delivery, I have also been told the opposite.  I would advise bringing your own food and snacks if possible.  Or having someone, other than partner, go out for some.
  • Clear liquids (broth, water, popsicles) are always available.
  • The nursery is between labor and delivery rooms and  "mom and baby" rooms.

• Other nuggets to know:
  • Cameras are allowed at any point but you cannot take video of the delivery, C-section surgery or any other medical procedure.
  • There are breast pumps at the gift shop at Duke Regional and with the coupon that you are given in the packet (handed out pre-tour).
  • You can wear whatever you want to at any point. I know I felt most comfortable, most like me, after the delivery in a gorgeous delivery / nursing gown that I had bought on Etsy.  You don't have to be wearing a hospital gown, if you don't want to. 

Tours of The Birth Place are free but must be registered for in advance.  Sometimes well in advance!  

What would you like to know, that wasn't discussed here?  Leave a comment below. 

In Part II, I will discuss what happens after delivery until discharge time.  Stay tuned!