Archive for November, 2007

Having sex late in pregnancy does not induce labor, researchers say

http://www.npr.org/templates/story/story.php?storyId=16618423

My loving hubby called me to let me know that there was a story on NPR about new research on labor induction via sex.   (The guy doesn’t really get my fascination with birth, and listens for hours on end when I talk about things like placentas and episiotomies and my thoughts on the management of the second stage of labor, yet calls me when a story like this is on!  Love him!)  Click on the above to listen then come back here.

As a doula, when my clients get uncomfortable in the last few weeks and start talking about how they can’t take another day of being pregnant, I have been listing out natural induction methods.  Sexual stimulation is always one of the things I mention.  (I don’t mention herbal methods of induction or castor oil, as I feel they are out of my scope of practice and should be discussed instead with their care provider as they are more controversial.)  I always assumed sex was the best method of my natural induction bag of tricks – semen has natural prostaglandins in it, nipple stimulation is often involved in sex and can bring on contractions, and orgasm contracts the uterus as well.  Given that the study and the speaker on the NPR story are from the medical (vs. the midwifery) model of care and I heard a couple of red flags, I think it may change how I talk to my clients during the last few weeks of labor.

In the past, here was my “normal” speech:  “I can hear how uncomfortable you are.  Would you like to hear ways to ease your comfort, or ways to encourage labor to begin?  (Client chooses to hear labor encouraging methods)  There are a number of ways to encourage labor to start naturally.  You can try…”

Here I think will be my “New and improved” speech:  “I can hear how uncomfortable you are.   You may have heard about many ways of encouraging labor to start on its own, such as walking and sex.  New research is showing that while these methods should work in theory, they actually do nothing more than increase your contractions for a few hours and get you excited, then peter out leaving you physically exhausted and emotionally frustrated.  Although it may be disappointing to hear that there is no good way to help labor along, it might be helpful to remind yourself that your body does know what it is doing.  The physiology of how labor begins is a very complex process, and even induced labor in the hospital does not mimic naturally occurring labor very closely.  Did you know that there are many chemical reactions that occur in the mother’s body to begin labor starting several days before you feel it, but that the very first reaction actually occurs in your baby’s brain?  So in fact, your baby will choose when s/he will be born.  How cool is that?  In almost every case, a mother will go into labor on her own, given the chance to do so.  And there are real benefits on waiting – a healthier baby and an easier labor being the big ones.  Your body is gearing up for labor, and the discomfort you are experiencing now will actually make labor shorter and easier when it does occur.  I know you are uncomfortable.  There is not a mother this far along in pregnancy that does not feel your pain, and I’ve been there myself.  My theory on it is that we are designed to be this uncomfortable in the last few weeks in pregnancy so that we actually look forward to the pain of labor when it begins.  But the good news is there are things you can do to ease your discomfort.  You can try a warm bath, hands and knees and other positions, hot and cold packs, massage, and distractions such as movies, shopping, dining out, visiting friends, baking, and starting a big project that you may or may not be able to finish before the baby comes.  Or you can practice your breathing and other coping techniques we’ve learned together and hone them so they’ll work better for you during labor.  Keep in mind that your body knows what it is doing and try to forget about due dates and other arbitrary timelines – you will go into labor when you and baby are ready.”

I’m starting to understand just how deeply the thought that we can somehow magically jumpstart our labor effects the mother.  When she tries something then fails over and over, it teaches her that something is wrong with her body and she learns to distrust herself.  She believes that her body is incapable of going into labor, so induction looks better and better.  And coupled with our culture telling moms that “37 weeks is full term” (can we just all stop saying that please?) and “I’m past my due date (at 40 weeks plus one day instead of at 42 weeks)”, unless the mom is steadfast in her resolve opts for induction, thinking that at least it will all be over and at least she can choose her doctor and her due date.  And we all know that an induced labor is not only physically more painful, but also usually comes with many more interventions because induced labor must be monitored more closely.  External fetal monitor, the IV (pitocin), perhaps internal fetal monitor or interuterine pressure catheter all have cords wrapped around mom, so mom is in more pain yet tethered to a bed where she cannot move to cope well.  And with induction, the increased likelihood of foreceps/vacuum assisted birth or cesarean birth all come into play.  And a mother who wanted a natural labor and got anything but (whether it was a few extra cords, or an epidural, or an assisted or cesearean birth) begins to resent her care providers, herself and possibly even her baby.

As a doula, having a mom second-guess her birth experience is absolutely the last thing I hope for my clients.   I want a mom feeling empowered about her decisions, whatever they are.  So while I will never try and stop a mother from doing what comes naturally *for her*, I’m going to stop with the old wives’ tales induction speech.  Sometimes learning to walk the “evidence-based practice” walk is hard, but it is well worth it.

Things I have been told this month that I already knew…

…but they hurt/helped (or both) anyway.

I am too hard on myself.

I don’t know when to quit.

My actions at times tend to set off a pretty messy chain of events.

People are lucky to have me.

I’m lucky to have people.

I need to let some things go.

People talk and perception matters more than the truth sometimes.

I need to accept that some people can’t fill my needs right now.

I need to either learn to accept rejection or stop looking for inclusiveness in people who are unwilling to give it to me.

It is not my fault.

I need to stop letting people put blame on me for things that were out of my control.

I need to accept responsibility for my actions.

I need to forgive myself.

I am remarkably self-aware.

If I stay in the moment, I will never go wrong.

Some people just don’t know what they need from me right now.

I need to move on.

I can’t keep punishing myself for bad decisions I have made in the past.

I’m just starting out on an exciting journey of self-discovery.

Dearest Bloglines

Dearest Bloglines:

You’ve always provided me with hours (too many hours!) of reading enjoyment and made me a few friends, none of which I will probably ever meet.  I’ve always visited you happily and earnestly.  But November.  I just can’t stand the sight of you.   And the reason is NaBloPoMo.

What am I to do when my favorite writers ALL write at least a post daily?  Do I ignore my life (been there, done that, got depressed) or do I ignore my blog friends lives (but I can’t stand to miss something)?

So I read.  But it leaves no room for writing.  So November has precious little posts here at americanmum.  Maybe the internets will thank me.

Baby Number 2 Born!

I spent last night with my second doula client helping her be as comfortable and emotionally supported during her labor as possible. As per my usual policy I’m not going into extensive detail here for confidentiality reasons. But here is the factual rundown:

– 19 year old primipara (first time mom), financially disadvantaged but marriage full of love. A pleasure.

– After weeks of on and off exhausting prelabor, 39 1/2 week induction: membrane strip in office, 3 hour later AROM (artificial rupture of membranes) that brought on good contractions nicely and steadily increased. Mom worked through them beautifully relaxed and rhythmically vocal.

– comfort measures I provided: foot massage, leg rub, back massage (lots of this – my arms are tired!), reminders to find her breathing rhythm, tub, reminders to change position, and some position suggestions

– this was never intended to be an unmedicated labor, although mom went further than I think she had assumed would happen and got into a nice strong labor pattern, making it through a couple of rough patches to find her rhythm again

– light epidural at 4-5 cm where mom was able to move her legs and still felt milder pain with the contractions. When they got continously worse, the nurse was called in and we learned there was a button she should have been pushing (to our memory, this wasn’t mentioned – oops!) Still breathing a bit through contractions but able to get some rest, if not actual sleep.

– after only 6 hours of labor, mom is complete, and pushes beautifully for 45 minutes to an hour – after losing strength “I can’t do this just get the baby out” she feels that baby’s head and is laughing and pushing stronger than ever. Doctor almost not gloved up for delivery and mom almost delivered baby herself – baby is 8 3/4 pounds!

– No Pitocin augmentation necessary. Only minimal repairs (1st degree).

– this was my first time supporting a partner – he was a really great calming and loving presence for his wife and charmingly emotional – he held her hand, had loving words whispered in her ear, and shared lots of gentle kisses and touches and had some beautiful tears when the baby was born – which got me teared up too!

– this was also my first time being the primary breastfeeding support. Baby has great instincts and sucking refexes, and would latch on perfectly but would release after 5-6 sucks – I was stumped and called in the reserves and the nurse suctioned baby out as he was quite plugged up. By that time baby was getting sleepy but would wake right up in dad’s arms. By the time I left, baby had a good latch.

I got home just as Rich was waking up to go to work. Kids were shuttled off to a friends where I got a blissful 3 hours sleep. Funny thing is – I’m not tired. Can I do it again? PLEEEZE?

Counting the days till my next client is due – on call after Thanksgiving.

Opening the chrysalis

I went off my meds yesterday and haven’t felt this good in weeks/months.  Maybe they were just a safe resting place I needed to get through a particularly rough emotional week?  At any rate, I feel strong and back on the trail of self-discovery.  Many of the problems that landed on my trail which had looked like giant boulders are now just little rocks that look easy enough to hop over, and the clouds have cleared over the summit and it looks closer than I had thought.  I will continue with the counseling and will be doing a lot of self-monitoring and self-reflection, but it feels great to be my energetic, fun, silly, emotional, idealistic self again.  I’ve missed me 🙂

Back to the drawing board

It is early in the morning and I haven’t been able to sleep. Could it be a side effect? Who knows, but here I sit so I might as well talk to somebody.

Last (this?) night I went to a costume party. Yes, Halloween is officially over – don’t ask. I’ve been so tired and didn’t really want to go, but threw some devil horns on my head and donned a red shirt and called it good. The party was amazing actually – they must have spent thousands of dollars to decorate. Although I was able to socialize fine, I wasn’t exactly the life of the party either. Sure, I’ve been wiped out from the meds I’m on, but that I can fake my way through for a couple of hours. The problem is that I couldn’t eat or drink.

I, apparently, have lost all taste for alcoholic beverages. There will be some who know me well that might insist that this is a good thing, but I insist it is not. Even standing with a shot of Bailey’s in my hand was making me nauseas. I could smell the alcohol wafting up to my nose like it was rat poison. And there was the most delicious looking spread of food lined out and I had no desire to place a crumb of it in my mouth.

“What do you do with a date that doesn’t drink OR eat?” I asked my husband. A question that apparently had no answer. We left the party at 9:45.

(going to talk about my sex life here for a moment…mom, dad and anyone else who wishes can skip the next paragraph…)

Not only have I had to force-feed myself for the past week because lack of desire for all things gastronomical, I’ve had no desire for the physical, either.  Just for the sake of finding out to what extent the sexual side effects are, the va-jay-jay was taken for a test drive.  It took for freakin’ ever, people.  I did not think I was going to get there.  I was close for at least 20 minutes, sweating like a pig, until frustrated and annoyed I finally squeaked out a less than climactic climax.  Honestly, it just wasn’t worth it.

So, I want to know, what good is a life without food, drink and sex?

My mind is quieted, yes. But my body is miserable. I still have floaty arms (like restless leg syndrome, but the other appendages), and I’m exhausted all the time. And I’m emotionally flat. With this comes an astute ability to reason, which is kind of nice in a Vulcan-ish way, I suppose, but it’s just not me. I am not reasonable, dammit. I’m ready for Cymbalta to release the death grip on me already.

Yet, as miserable as it is to be in my body right now, it may get worse. I’ve recently read up on some horrible Cymbalta withdrawal symptoms. Yes, these are just some message boards and the worst case scenarios, but it just is a reminder that I am not playing with Tinkertoys here. This is serious stuff. But it just makes my resolve stronger to stop the stuff before it gets worse. Luckily I’ve only been on the stuff for a week so I don’t expect to suffer from any agitation, “brain zaps” (?) and other horrific sounding sensations.

A lot of the issues that were spinning around in my head previously have found a place of resolve in my life. I think I am going to be able to continue to face them bravely off the meds. I promise, though, that if I am not able, I will be right back in to the doctor’s office for a new prescription of something else.

Sure, my mind has been quieted. This is a good thing. But, sitting here with a clear head (but a miserable, tired body), I can’t help but think that there must be some other way. Another medication? Perhaps. But I’m starting to lean toward giving some alternative treatment a try – acupuncture and some St. John’s Wort might be the first line of defense.

Perspective

A week ago, I was trying to describe to Rich what it felt like to be depressed. I told him that it felt a lot like driving for a long, long time in the middle of the night and being so exhausted, but being hours from your destination and having no where to stop and take a rest. Or – having a high fever and feeling achy, tired and confused. Add hating yourself to that equation and you’ve got a pretty good picture of it.

Okay, I have never quite hated myself. A lot of self-doubt and negative inner thoughts, but no self-loathing. Underneath it all, I’ve never stopped liking the person I am. That was just a poor attempt at some humor.

Anyway, the meds are definitely kicking in. I no longer feel as clouded in my thoughts, and I can think on things without a sense of helplessness and dread. I can turn off the circle of unproductive thoughts that still try and spin around in my head from time to time. However, I still have some unpleasant symptoms from my medication – I can barely keep my eyes open and after lunch I can’t operate without a nap. My arms still feel all noodle-y. The good news is that the nausea seems to have worn off. I’m hoping that the rest of the symptoms are introductory only and will disappear soon enough.

With less clouded thought, and with the help of counseling and a few frank discussions with loved ones I am starting to gain some constructive self-insight. And with the medication, I have the courage to face it without falling into a vortex of guilt and helplessness.

I have known for quite a while that the biggest thing holding me back as a human being is that I doubt my own social ability. I fear that I am flawed in some way, and if people get to know me deeply, they will see it too and run for the hills. It’s probably why I feel a lot safer with internet friends lately. I’m realizing that while, like anyone, there are some things I certainly need to work on, much of my problem is this negative self-talk that is becoming a self-fulfilled prophecy. I think I’m different, don’t handle social situations well, say exactly the wrong thing at the wrong time, want so desperately to help people and have the best of intentions but sometimes hurt them instead because I don’t have the skills to handle myself gracefully.

So, with all this spinning around in my head all the time, I over-compensate by trying too hard, sharing too much. Or I have so much fear that to others it looks like I don’t want to get to know them at all. Or I try and look overly confident or competent. Or I hold myself back from people so I don’t hurt them or myself. Or I say I must find people exactly like me, as they are the only people who would truly understand me. Or I talk about myself more than I should because it is more comfortable than dealing with others’ feelings that I assume are negative. All this scares people away, or makes them think that I am not interested in them, and they pull back. I see that as proof of my own flaws and proof that when people really get to know me, they don’t like me very much.

(Wow. I’m pretty messed up.)

Anyway, how do I break this cycle? That’s the next step. My current task in therapy is to be more frank with people when I hear those self-doubts starting to creep into my head. Doing this, hopefully, will show me that most of my assumptions about others’ thoughts about me are wrong. For instance – if a friend seems distant with me, I need to say, “I’m sensing some distance from you right now. In my head, I’m thinking it’s because I said something or did something wrong and am assuming it is x that I said last week. Is that right?” And hopefully they will correct me.

This all sounds well and good, but I worry. Of course. I worry that I won’t be able to say those words without sounding like a social buffoon (there’s that voice again). The words will come out all wrong and I’ll just look pathetic or ridiculous, or hurt someone with them. Will words like that turn people off, or show my insecurities? It all sounds so easy when my therapist says it, but she’s polished and the words come easy for her.

On the upside, I can see how much this work could help me. If I can get past these thoughts, I’ll be a better wife, mother, friend, daughter, sister, doula. It will help me infinitely in all my relationships. And I’ll be unstoppable.

But no one said this wasn’t going to be a lot of work.

(More upbeat, off-the-depression-topic post soon, I promise.)


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