Saturday, May 10, 2008

Two womens' labors and the quality of care

Two women asked me about CPD earlier this week.
CPD is cephelopelvic-disproportion, meaning the baby doesn't fit the pelvis.

One woman was a first time mother working with our home birth midwifery group. She was at the end of her pregnancy with an OP baby. Body work hadn't helped her baby get turned to face her hip or back. The baby hadn't engaged. Being well read, she was now concerned that the baby wouldn't enter the pelvis and a cesarean would then be necessary.

Another woman emailed from the UK. She was pregnant with her second and remembering her first birth. The baby hadn't engaged. She had an early urge to push. Her midwife yelled at her, her words, to stop pushing. This went on and on. An epidural gave relief, but too much, she was put on her back and now had little ability to push when the time did come to do so. A vacuum, or ventouse, extraction was done. She was a bit afraid to hope for the coming birth of her second child.

Our first time mom had a strong urge to push before her cervix was fully opened as well. Instead of trying to stop her, we observed. Later, we encouraged her to push along with the urges. We alternated with asking her to breath through some contractions without pushing. Then, again, she let her body push spontaneously.

Her baby's head needed time to mold, so we asked her not to add to her body's spontaneous pushing. An asynclitic angle (tipped like listening) of the head was a significant factor in the length of time, so we asked her to push. We were exploring what might be the best way to help her. We tried varying how she pushed because this urge went on and on, like the UK woman's labor.

All the time her loving husband stayed at her side, patient and attentive. Her doulas stayed near. Her midwives honored the needs of the birth and introduced a very pointed conversation, gently. By stating that we wanted her to get what she needed, she took that idea around in her mind for a couple of contractions and replied that she was ready to explore what the hospital might have to offer her labor. IV fluids, Pitocin (Sintocin).

In the hospital there were a few more hours until, finally, the cervix was gone. The baby's head had molded enough and the mom's voluntary pushing now became effective. Now she pushed hard enough to realign the plates of California. Her baby was born, healthy and strong.

Both women had difficult births. Both were able to birth without surgery. One woman feels raped. One woman feels empowered.

Penny Simkin says we can't control how labor will go, whether difficult or not, but we can control how we care for women. She was referring to the respect, words and tone we use when talking with pregnant and birthing women. (Postpartum, too!)

I'll add that we can seek to honor the needs of labor, too. The clock is not a good guide for intervention. Giving the woman, in a non emergency situation, time to decide when its time for an intervention (perhaps as a tool for a long labor) considers her needs in the psychological transformation that partuition is. She needs to know her midwives not only hear her, but trust and know the variations in birthing.

Her decision is made not only from her physical and mental state, but made within her support community. She makes decisions among people who are important to her. This is part of her mother-making. A key part.

How the dream birth becomes the real birth is how the dream of her mothering becomes the mothering she actaully experiences. How her support people, including her midwives and doctors and nurses, respond to her needs and how they nurture her changing birth plan reflects on her acceptance of herself as a woman and a mother in her circle.

Choosing transport and an intervention doesn't mean that all her effort is done. There is more effort, more work. Contractions continue and the mother continues to labor. She is brought to yet another level of challenge. The challenge of having thought an intervention would remove effort and finding that it does not. It may help effort, but it does not remove the mother from the work of becoming a mother. She is in the midst of hard work. Work that is rewarded with a conscious connection to her child and to her awareness of the process of mothering.

All mothers deserve to be rewarded in the art of surrendering themselves for the needs of their children. There is not a mother that doesn't deserve our respect for that. Its not a question of the worth and beauty of mothers.

Its a question of how we care for women as they become mothers and the effects of our care on the quality of life for mothers and their babies.

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Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.