An Anesthesia Doctor's Wish: an Unmedicated BirthCategories: labor & birth, mental health, pregnancy
Tags: epidural, anesthesia, anesthesiologist, unmedicated birth, VBAC, birth, Rebecca Zanconato
October 25, 2015
GUEST POST by Rebecca Zanconato, MD
By the time I completed my first month of obstetric anesthesia training, I had concluded that every woman admitted to labor and delivery was a disaster waiting to happen. No one ever specifically said this to me during any of my training, but in speaking with fellow residents I found that just based on our experiences in training we had all come to the same conclusion. Now, six years and three children later I have a very different view of childbirth. But, I share my experience with my training to illustrate the fact that many medical professionals learn to view childbirth as a dangerous process.
So, when I was expecting my first baby, despite the fact that I was a completely healthy, active person, I really thought that the most I could hope for was to have a healthy baby. I didn’t give much thought as to the type of birth experience I was hoping for and I figured I didn’t have much say anyway. As far as I knew, I had very little control over anything that would happen during childbirth. I had very little exposure to pregnancy and childbirth in my personal life and so I didn’t even know what resources were available to prepare for childbirth and parenting. Most of the women I knew told me to demand the epidural as soon as I got to the hospital. This was pretty much the extent of the advice I got from other Moms.
I felt great while pregnant and I loved almost everything about being pregnant. I was excited to welcome our baby into our lives. Despite my training I didn’t feel afraid of childbirth. I wasn’t sure what to expect, but I figured we would manage fine. After all, lots of women have babies!
My pregnancy was uneventful until two days before my “due date.” I went to my scheduled doctor’s appointment and my blood pressure was found to be elevated. An in office ultrasound found the baby to be measuring small. If in fact the baby’s growth had been affected then that met criteria for severe preeclampsia. The decision was made to induce me. Although I knew that this was the appropriate treatment I didn’t have a good feeling about being induced. The baby had been doing so well-lots of movement, and I still felt great. It was very difficult for me to accept that this was happening
Not surprisingly, the induction didn’t go well. I felt alone and miserable and I was worried about the baby. After about 36 hours of little progress the decision was made by the on call Obstetrician to rupture my membranes to try to move things along. The baby’s heart rate didn’t respond well to this and I was then placed on strict bed rest. I ended up agreeing to an epidural and soon after that I had an emergency C section for fetal distress.
The surgery was uneventful and our baby was born screaming crying. I could tell by the cry that the baby was perfectly fine. Our son was brought to the head of the bed for me to see and then went to the nursery with my husband while surgery was completed. He was brought back to me when I arrived in the recovery area. This was not at all how I had hoped birth would go, but I was thankful that our baby was healthy. After all, based on everything I had seen in training, this was really the most I ought to hope for.
Over the next several months I didn’t reflect too much on my birth experience. We were busy and tired with a new baby, but also, it was a painful memory. Part of the pain was related to my personal life and the state of my relationship with my husband, but part was also related to what actually took place in the hospital. I also felt guilty for being at all dissatisfied with the experience I had. I had a healthy baby and I was basically fine after I recovered from surgery. My training told me that for me to expect more was being selfish. But when I reflected on our son’s birth, I felt like something had been taken from me. At the time I couldn’t really explain it any better.
Nine months later, I was very happy to be pregnant again. I knew that I wanted a different experience for this birth, but I still didn’t really know where to look for help. I was very lucky to find out about Babies in Common about half way through my pregnancy. I signed up for a natural childbirth class offered there. I was hoping to have a VBAC (vaginal birth after C section) and I thought natural childbirth would give me my best chance at avoiding another C section.
The class was fantastic! My husband even enjoyed it. The class covered so much and helped me to really formulate a plan as to what specifically I wanted and didn’t want for this birth. Furthermore, the class provided a lot of suggestions as to how to work with hospital staff in order to have the type of experience you want with a hospital birth. It also helped me to prepare for an unmedicated birth, providing a plethora of coping techniques and resources for labor. After the first class we decided to hire a doula. She was a tremendous help for us and now I can’t imagine going through labor without one (and neither can my husband). From the class I found out about many online and printed resources and I started reading immediately-as much as I could. Finally, I also began acupuncture as it can be useful for pregnancy, labor, and high blood pressure management (my blood pressure never returned to normal after my first pregnancy). As with my first pregnancy, I stayed active, did prenatal yoga, walked/ran, and was careful about eating well.
I would love to say that my second experience was quick and easy thanks to the class and having a doula. But, it wasn’t so straightforward. I am sure though, that without the above preparation and support for this second birth, the experience would have been drastically different. I don’t believe that I would have been able to have the VBAC that I had without Babies in Common and our doula.
This time, I had rupture of membranes, but after 36 hours of intermittent contractions I was still not in labor. My doctor and I agreed that trying some pitocin was reasonable at that point. This did get labor going, but again labor was progressing slowly despite a fair amount of discomfort. After a while I was simply too tired to manage and I requested an epidural. Soon after, the baby’s heart rate dropped. An internal monitor was placed on the baby. C section was mentioned while this was happening, but fortunately the baby’s heart rate recovered with position changes. Sometime later it was time to push. After hours of pushing a resident told me that the baby had not moved at all. I was told that “some babies just don’t come out.” I couldn’t believe this. I had ruptured membranes and had been working at a vaginal delivery for over 50 hours and now I was being told that I would probably need another C section. Tears rolled down my face. The on call Obstetrician said he could try a vacuum delivery, but if that didn’t work I would need a C section. So, I agreed to an attempt with the vacuum.
The vacuum worked, and again, our baby let a loud cry as soon as it was born. There was no doubt that it was OK. According to protocol for vacuum deliveries, the neonatologist evaluated our son immediately after birth. He took a quick look at him, congratulated us, and said goodbye. I was so happy and thankful to have had a VBAC. It was challenging, but so rewarding in the end.
It took about 45 minutes to repair my episiotomy and 4th degree tear. During this time I don’t know what was being done with our baby. I couldn’t see and I was so sleep deprived that I really didn’t know what was going on around me. All I wanted was to hold our baby and give him a chance to breastfeed so that I could then sleep a bit. It was over an hour before I held him and then soon after I held him I was told by my nurse that she needed him back for an assessment. I felt frustrated and confused, but I was too exhausted to challenge anything that was happening.
Later that day I began having episodes of lightheadedness with standing. Eventually blood work revealed that I was bleeding a lot, apparently from the severe tear of my perineum. I had lost so much blood that I couldn’t even sit up or get up to attend to my son. So, he was not able to stay with me in my room for his first night. I felt terrible and was worried about the impact this would have on breastfeeding and his overall wellbeing. My nurse did bring him to me several times overnight, but I still worried about the effect this would have on us.
Once I recovered from childbirth, I began thinking about both of my birth experiences, wondering why I seemed to be having a lot of trouble getting into labor and progressing in labor. I remember saying one day to my husband “Why is it that I can carry a baby just fine, but I can’t give birth?” I really felt like my body didn’t work and I couldn’t understand why. Part of me felt like a failure. Another part of me felt guilty for complaining or being unsatisfied with my experiences. After all, I had two healthy children, and I felt great during both of my pregnancies. Many women struggle with feeling awful tduring pregnancy or struggle to get, and stay, pregnant. How could I complain when other women were dealing with much greater difficulties?
I spoke with Jeanette, at Babies in Common, and a few colleagues, about what might be contributing to my difficulties. Our first two babies were not ideally positioned and I suspected that that was part of the reason my labors didn’t progress well. Of course, their position could also have been related to having an epidural. There is no way to know. Prior to my third pregnancy I had several myofacial release sessions to try to help improve pelvic alignment. I also started seeing a chiropractor and continued to throughout my pregnancy. I had never seen a chiropractor in pregnancy before because I never had aches or pains. I didn’t realize that a chiropractor can help tremendously with keeping the pelvis well aligned to help with better positioning of the baby and uterus.
During my third pregnancy I again stayed active and felt great overall. I also sought out information about exercises for better fetal position. I read almost the entire “Spinning Babies” website and did many of the exercises recommended there throughout pregnancy. My husband and I also took a refresher class at Babies in Common to review techniques for managing in labor as I was planning for unmedicated childbirth. I also met with Jeanette for an individual prenatal consultation. During that session we addressed some specific concerns I had related to my previous experiences. We also discussed and made a long list of things to do to keep me and the baby healthy through the remainder of the pregnancy, to try to get labor started, and how to manage if again I ended up being induced and/or laboring for a long time in the hospital.
It was fortunate that Jeanette went over what to do if I needed to be induced, because once again I was induced with my third baby. I had really been hoping that I would go into labor on my own as again, I thought that would give me the best chance at another VBAC and hopefully one without complications for me or the baby. I held off on the induction as long as my Obstetrician felt comfortable, hoping that labor would start on its own.
The night before I was induced I lay in bed and sobbed for about an hour. The baby appeared OK at that point, except that the baby had been measuring small for several weeks. I was worried about how the baby would tolerate an induction. I was also worried that if my body didn’t respond, as with the previous two inductions, that there could be complications for me or the baby. I trusted my Obstetrician, but I worried that by being induced I might end up causing a problem for my baby when at that point it appeared to be doing fine.
I arrived at the hospital the next morning at 7am. When my Obstetrician came to see me he said the plan would be to start pitocin and then eventually break my water. I asked what the options were for trying to get my cervix more dilated before starting pitocin. I also expressed my discomfort with breaking my water as that appeared to have contributed to problems with our first baby during labor.
It was very difficult for me to tell my doctor that I wasn’t completely comfortable with the original plan. I am the type of person that mostly does what I am told and doesn’t ask questions. But, I knew that if I didn’t say anything and there was any negative effect on the baby I would feel responsible.
With this induction we were very fortunate. Everything went well-and fast! In the morning my Obstetrician told me this would typically take 8-12 hours. I laughed when he said that to me because I simply didn’t believe that it could ever happen that quickly for me-not after my previous experiences. However, in just over 8 hours, we had a healthy, and normal sized baby girl. The birth of our daughter was an amazing experience for me and my husband-the most amazing of our lives. Unmedicated childbirth was so different from the previous experiences I had had and it was an unbelievable feeling. Immediately after she was born she was placed on my belly. I felt great and was able to keep her with me all night-holding and feeding her. I just didn’t want to put her down and miss any bit of time with her.
So, after having three children I now know that the great majority of births are not a disaster waiting to happen. In fact, most of them have the potential to be wonderful births without any major complications. I think it is unfortunate that many women have experiences somewhat like my first two births, but relatively few have the opportunity to experience a birth like the birth of our third baby. What seems strange to me is that of the three experiences I had, the third was what I would consider the most “normal” birth experience. As my husband said, “It just seemed like how a birth should be.” So, why is this not how many births are and what can be done to help change that?
One challenge that I believe many women face in our culture is that most of us have little exposure to childbirth until we have our own baby. Most of us don’t know what to expect or how to prepare. The exposure that we do have is often sensationalized by media, or it is hearing about negative and/or complicated experiences other women have had. I don’t think that many women hear much about or see uncomplicated, natural childbirth.
I believe that women and their partners can help others simply by sharing their experiences. By reinforcing the idea that childbirth and pregnancy are normal, natural processes, we can help change people’s views of childbirth. We can help take away the fear that some women feel and help women to feel empowered.
I also believe that we can help other women by sharing educational and inspirational resources-books, websites, classes available, … I would have loved it if someone gave me one of Ina May’s books to read when I was pregnant with my first baby, or told me about the spinning babies website.
Women deserve to have amazing, empowering birth experiences. Unfortunately, I think that many people believe that this is a rare occurrence and not necessarily “normal.” I believe that the more people realize that this is possible for most women, the more often women will have amazing, empowering births.
So, as a mother and anesthesiologist here is what I would recommend to women preparing for childbirth (and I assure you, this is what I will be doing if we have another baby). Seek out as much helpful and positive information as you can find; read books, online material, articles, … Take classes with an independent educator to prepare for childbirth, breastfeeding, and newborn care (like the ones with Jeanette at Babies in Common). This will help you obtain information, give you the opportunity to ask questions (very helpful!), and let you know about other resources that may be helpful for you. Watch videos and movies that show pregnancy and childbirth in a positive way. Help your partner be prepared with you by taking them to classes, providing them with written material, and watching movies and videos with them. I realized how important this was when taking classes during my second pregnancy. Prior to that I was only thinking about preparing myself. I didn’t realize that much of the preparation is planning for what help you will have during childbirth, because no matter what type of birth you have, you are going to need help. Along this line, I strongly recommend hiring a doula to support you in addition to your partner or other support people. Doing so is not a slight to your other support people. Your doula is there to help you and your other support, not to replace them. Finally, be positive and remember that birth CAN be normal and wonderful!
A note from Jeanette
Have YOU had any similar experiences to the one above? Comment below!
AND, a huge THANK YOU to Rebecca for writing such a detailed and honest article about her experiences!