Time IS on Your Side

Preparing for class is always enjoyable for me.  This morning, I've been reviewing my materials for class 2 where we focus on the early or "latent" phase of the first stage of labor.  In doing so, I've been reading up on Frieman's Labor Curve and the new ACOG recommendation to reduce primary cesareans.  It all centers around time--how long is normal, what risks are associated with waiting longer, is labor to be gauged by the amount of time mom feels contraction or her dilation?  It seems stupid to me that a massive crew of experts got together and said essentially, "If we wait until more women are actually in labor to admit them to the hospital, we will lower the primary cesarean rate."

That's progress?  That took days of meeting and presentations?  Admitting women to the hospital just because they are contracting is silly, but it's what most often happens.  I cannot tell you how many times I've been told or read things like, "At my appointment, I was having a lot of contractions.  You could see them on the monitor, but I didn't feel them.  The doctor told me to go on over to the hospital!"  There are so many things wrong there.  I'm not quite sure where to start.

If you cannot feel contractions, they don't count.  Just because you are contracting, does not mean you are progressing much less in actual labor.  This is NOT evidence-based care.  This kind of care increases risks to you and your baby despite the false sense of control a scheduled birth may give you.

Hospitals must stop being afraid to send mothers home to wait.  They must also stop offering social or convenience births.  They must also stop rupturing membranes as an initial step in the induction process so a mom can go home and try another day if things just are not progressing.  Very rarely do the risks of staying pregnant another day or two outweigh the risks of having an emergency birth, cesarean or vaginal, for you or for baby.  Forcing an induction when your body just isn't ready increases risk of forceps and vacuum, episiotomies 3rd and 4th degree tears, and finally a cesarean birth.  All of those same risks still apply when you are admitted in early, early labor and the cascade of augmentation begins.  I often wonder how many people were actually induced when they think they were augmented.

Another favorite of mine is, "Well, I'd been having contractions for a while, so we decided to go on in."  Could you walk?  Talk?  Were you still laughing, putting on makeup, maybe fixing your hair between them?  You can have episodes of contractions for weeks before labor starts.  Many women experience prodromal labor almost every night for the last week or two of pregnancy.  It's normal.  It's not pathological--"I just can't seem to go into labor."  No, instead of that try shifting your thinking to: "My body is getting ready."  Even if there is no cervical change, those contractions may be helping to position your baby.  They give you a chance to practice coping with contractions.  Your best bet is to wait and rest up as much as possible.  Go about your life until they demand all of your focus and energy.

Care providers must be more patient prior to labor and "allow" a woman's body to start labor on it's own.  Most women will begin spontaneous labor between 38 and 42 weeks gestation not 38-40 weeks.  A huge proportion of cesareans would not happen if doctors customized care and waited to intervene at 42 completed weeks as suggested in Williams Obstetrics.  Of course, that is not always appropriate, but it's up to each care provider to customize care to fit that situation.  It's abundantly clear that one-size-fits-all maternity care isn't working out so well.

Mothers have to be better prepared to wait and recognize true labor.  Yes, you need more information and support than what your doctor provides.  Yes, it's hard to wait.  Yes, you are big, maybe uncomfortable, tired, whatever.  I've been almost 42 weeks pregnant in August.   I knew what the signs of real labor were, and waited out a day of contractions at 34 weeks most likely caused by dehydration and doing too much.

I've been with a mom having contractions 3 minutes apart at 38 weeks.  We went to the hospital.  She was about 5 centimeters dilated.  The contractions stopped...for hours...maybe forever.  The nurse gave her the choice--you can stay and the attending doc will want to start piton or you can go home and wait.  She went home to wait.  The baby came 10 days later.  She had the confidence in her body and the information to step back and realize that contractions do not always a birth day make.

I have another friend who just had her baby at 42+3 with the support of a wonderful doctor.  It is your choice.  It's your provider's job to be honest about what choices are safe and be respectful of your wishes.

There is so much more to early labor, hence we spend a whole 3 hour class focusing on it, but here is the bottom line: it's your choice--your choice to pick a provider who will offer you individualized, evidence-based care; your choice to prepare yourself with information, tools for labor, and patience;   your choice to do your best to have a healthy pregnancy; your choice where, when, and how your baby is born.

Haitches

The Rain in Spain reduces me to giggles still.  Children have made it even funnier.  Their mispronunciations and grammatical faux pas butcher the English language as much as Audrey Hepburn's put-on Cockney.  True Cockney is as unintelligible as the Cajun coach on Waterboy, just pray you catch a few key words and are an apt student of body language.  It's your only hope.

Eliza's "haitches" are particularly hopeless and horrendous.  I love the etymological roots of our letter "H."  Is it a vowel or a consonant?  Haitch or aitch?  I'll refrain from indulging myself in a grown-up Sesame Street sing along for today's letter of the day, though it might be fun.  Is it an English major thing?  A book worm thing?  I get on a letter and brainstorm all of the words I like that begin with it.  Much like after reading Shakespeare, I have to check myself to keep from speaking in iambic pentameter.  Unless you need good wording for a child's birthday party, that shit's just annoying.  The patterns or words fascinate me--the rises and falls, the harmony and dissonance.

As I start working on revising my blog's look and purpose, I thought about why I named it Mississippi Hippie Mama.   Am I really a hippie?  What on earth is a Mississippi hippie?  Why even keep Mississippi in the title?  I haven't lived there in almost ten years.

Mississippi is in me.  You can't beat it out of me.  It's not going to gradually wear away with time.  It's just there.  It's a poor and proud little state.  It gets torn down by natural disasters and it's own internal turmoil and politics, but it hops right back up.  It's a brave and giving state.  It's got the best music in the world, the best food, the best people.  Have you ever thought of all of the talent that comes out of Mississippi--the musicians, the writers, the actors, the artists?

Mississippi stays.  Faulkner nailed it when he said, "To understand the world, you must first understand a place like Mississippi."  I cannot define myself or tell my story without Mississippi in all it's complexity.

I probably would have enjoyed some of the philosophies, people, and parties of San Francisco's Haight-Ashbury in the 60's, but I would have enjoyed the new Pucci boutique on the designer row as well.  That's a big part of why I say Mississippi hippie.  Every place we have lived, people ask where I'm originally from.  "Oh, you're a Jackson girl," they say like that explains it all.  What on earth?  Are we that distinct?  I don't wear heels and makeup every single day anymore. Does the Jackson cultural equivalent of Eliza's diphthong deficiency still linger?  Apparently so.

Yes, I like yoga, wear busted Birkenstocks, diffuse essential oils, ferment things on my granite countertops, breastfeed indefinitely, embrace informed decision making, forgo sunscreen for that vitamin D, sew clothes for my kids, hoard mason jars, have babies at home, use coconut oil for everything (yes, everything), cosleep, think GMOs are the great satan, and idealize "intentional living communities."  I also love red lipstick, designer denim, a good party, the internet, setting a pretty table, vampire novels, beer, Clorox, Miss Manners, angry rock and roll for running, interior design, monogrammed stationery, finger sandwiches, and codeine cough syrup when all else fails.

It's like wearing amber with pearls or a diamond drop, both of which I've done.  I'm not picking.  The H stays.  In fact, I don't love the word hippie.  It's kind of silly, maybe even a pejorative depending on who drops it as a word bomb.  Lots of other H's fit:

Healthy, holistic, happy, helpful, homemade, happy-go-lucky, honest, hausfrau, and harmony-craving.

I am also harsh, half-cocked, hurried, hormonal, hard-headed, hasty, and maybe a dash heretical.

Most of all I'm human.  If you can't find a seemingly irreconcilable difference within your predilections or preachings, dig a little deeper.   You are one of two things--a liar or a bore.  There is no neat, simple solution.  I'm both, two things diametrically opposed--southern traditionalist and non-conforming free-spirit.  Instead of, "If you can't say anything nice, come sit by me," my motto should be, "If you can't quite fit in, come sit by me."  I usually find a way to blend the overlapping edges just like a good eyeshadow application, shifting between circles like the outfit that can go from day to night out with a change of shoes.

Don't cram yourself into one teeny, limiting box.  That's just no fun.  Be complicated, be controversial, be genuine.

Beer and Emergency Birth

Those two things do not fit together.  I can see it, too.  I'm southern.  I chit chat.  People tell me things.  Odd topics get related.  We talk about who our people are.  We make connections.  It's like a game.

Abita Mardi Gras beer--does it get much better?  Well, if you get to talk to an EMT about catching babies because of it, yes.

Here's how it happened--I'm at the grocery store checking out.  The cashier is ringing up my beer, so we naturally start talking about beer.  We both agree that we really enjoy a nice flavor.  She likes an apple beer and Southern Pecan, so I tell her that Lazy Magnolia Brewery's other good one is Indian Summer.

We both agree that plain old beer now tastes like pee.

"Oh," I say, "Excuse me, that was vulgar." 

"I'm an EMT.  That's nothing," she says with a smile.

I tell her I'm a doula so pee and bodily functions in general don't phase me.  I've blotted bubbles of meconium (this is normal with breech babies as they get squeezed down like a tube to toothpaste) off a breech baby's bum as she was being born and wiped a pushing mama before.  It's just not a big deal.

"That's one thing I haven't had to do yet--deliver a baby."

Hmmm, me either, but opportunity is calling my name.  I tell her that precipitous births are usually pretty safe and healthy.  All you really need to do is catch.  She says that's what she's been told.

The one thing in EMT births that always bothers me is how the cord is handled.  I've heard 2nd hand and from EMTs that telling parents to tie off the cord with a shoelace is still in the script.  Yikes!  Why not whip off that shoelace and flush it in a dirty toilet a few times.  It might clean it up a bit.  I cannot think of many things that get nastier than and old shoelace.

So, I smile and say that other than catching, put baby right onto mom's bare chest and leave that cord alone (that might have come out more as a threat).  It's still giving baby oxygen as long as it's pulsing.  She is interested.  She didn't know that.

The main myth I aim to dispell about cord clamping is backflow--the blood being transferred from placenta to baby will not backflow!  It is being pumped, so it is pressurized.  Now, gravity can affect how much is pumped in or out, but immediately clamping for fear of the blood draining out of baby is absurd.  The actual reason we clamp immediately comes from the days of twilight sleep and general anesthesia--the drugs used to knock mom out were so dangerous to baby that getting baby away from the influence asap was critical.  What else does that tell us?  That pain medications given to mom quickly cross the placenta and affect baby?  Yes indeed.  This same reason is why narotics like stadol, nubain, and fentanyl are not used near the time of birth.  They are known to negatively affect baby's breathing.

I quickly tell her that blood backflowing is a complete myth and that there is a substance called Wharton's jelly that beings to naturally stop the flow within the cord usually about five minutes after birth.  I reminded her that unless you have a NICU handy, it's not a good plan to cut off baby's source of oxygen.  It creates a problem where there was none and buys you time to get to safety.

All of this transpired in about 3 minutes.  It was kind of neat.  I might find a baby-friendly set of emergency birth instructions to pass her the next time I'm shopping.  I should probably keep a set* in my doula bag.  The workbook we use in class has a page for emergency birth.  It doesn't happen all that often, and I would never ever use them to replace an actual birth attendant (midwife or doctor).  I am in no way, shape, or form qualified to catch a baby.  I would in an emergency if I had to, but I would not encourage an intentional "oops-we-didn't-make-it-to-the-hospital."  It's all about using evidence-based practices.  They improve safety and outcomes no matter where you are.


The first of 3 grand rounds videos:
http://www.youtube.com/watch?v=W3RywNup2CM
http://summaries.cochrane.org/CD004074/effect-of-timing-of-umbilical-cord-clamping-of-term-infants-on-mother-and-baby-outcomeshttp://www.midwiferytoday.com/articles/neonatalresus.asp
https://www.youtube.com/watch?v=W3RywNup2CM&feature=kp
http://www.mothersofchange.com/2012/01/whartons-jelly-miracle-tissue.html

*It was frustrating to see this ACNM PDF referenced all over the place and not easy to access in full form.  Do not use in place of a care provider, but in the event of a precipitous birth or other emergency, it's a good one.