Sunday, January 13, 2008

"Stalled" labours no more!

Births, like many things in life, don't happen on a schedule. They seem to follow their own patterns, kinda like the kid who is shorter than all his classmates at the beginning of grade nine but ends up a head taller than the rest of them by the end of the school year.

Some women give birth in two hours flat. The rest of us ordinary gals wish we could birth like that, but most fast birthers will tell you it is somewhat overwhelming (what an understatement I'm sure!)

Some women give birth in under 24 hours. My first labour was like this, about 15 hours start to finish. Most of it was spent in the quiet peace of my home, coping with contractions and spending the wee hours of the morning in my tub. The last three hours were spent at the hospital.

Then there are the rest of the gals out there. For some women, their body likes to work through labour and delivery over a longer period of time. I'll give you an example of how labour can go for one of these women: baby drops one day, three days later contractions start coming regularly for a number of hours. Mom is excited- this is it! Then the darned things stop. Her body has (effaced)thinned out her cervix, then taken a rest. She is frustrated but she waits. A few days later labour kicks in again. She dilates (her cervix opens) to 3 cm. Then contractions stop again. 24 hours later labour kicks in again, and after eight hours of contractions she is fully dilated- her cervix has opened to 10 cm. Mom feels sleepy, her contractions have stopped, so she lays down to have a nap. 45 minutes later, she wakes up with her baby halfway down the birth canal and breathes her baby out.

Are you reading this in disbelief? Are you thinking that it's impossible? That you've never heard of a labour like that before? Births like I have just described ARE rare, because when we follow modern obstetrical protocols we just don't usually leave a birth to its own devices. Mothers with "stalled" labour are given drugs to speed up the process. They are led to believe that their bodies, for some unknown reason, don't work properly, and they need assistance. Their births are also pushed along because stats show that the longer you are in labour the higher your risk of infection. So the slow birther is going to have her birth pushed along with interventions that all increase her sensation of pain, her need for more drugs, her chance of a cesarian section, and the chance her baby will need attention in the Neonatal Intensive Care Unit (NICU).

Here's how a midwife/doctor/traditional birth attendant who believes in a woman's ability to birth her baby will deal with this scenario:

1. Vaginal exams are not performed. Your birth attendant understands that your risk of infection is directly correlated to how many vaginal exams you have before your baby is born. Even a sterile glove is going to introduce bacteria from the air, from the practitioner, from your external genitalia up inside your body. Of course your chance of infection will be increased! Your attendant can tell that your labour is progressing without the need for internal exams.

2. Your bag of waters is not broken. This practice has been thought to help speed along a labour. Even in studies that showed a shorter labour and birth, the difference was only half an hour. The risks associated with the practice, including higher infection rates and fetal distress, drastically outweigh the benefit of a slightly shorter labour.

3. Your are encouraged to move and rest according to how you feel. Your practitioner will allow you to decide what is best for you. If you feel restless, you might want to pace the floor. If you are sleepy, you can have a nap. If you are hungry, you eat what you can tolerate.

4. You are assessed to see if your baby is in a good position for birth. Some babies are in awkward positions which draw out a labour. By massaging your belly and listening to your baby with a fetoscope, your practitioner can figure out how he or she is positioned in your uterus. If your baby is poorly positioned, your practitioner can suggest positions to help your baby turn, perform external massage to help him turn, or, as a last resort, perform manouevers during a vaginal exam to help your baby be in a better position.

There is no hard and fast rule that says once you go into labour, you MUST have your baby. A good practitioner will pay close attention to your health and your baby's health, and support you to make sure you are well rested and nourished during a drawn out birth. They can help you to deal with contractions, and, most likely, once you become further dilated (your cervix is more opened up), you will stay in labour that continues to progress without long breaks. You and your practitioner should also be aware that sometimes your body will stop labouring due to external stress. Perhaps you are nervous in a hospital, and need extra reassurance. Perhaps you invited too many people to your homebirth, and your original plan of a joyful party is now leaving you wishing for privacy. Together you can make adjustments to your environment to help you feel comfortable.

In my opinion, this kind of birth is most easily facilitated at home. Your practitioner can focus on a quality experience with you instead of following rules about what stage in labour you should be in based on the clock. Then, years later, you can talk about how your child, who is always slow to get going in the morning, did the same thing when he was makes for a cute story ;)