Staying In Charge

"Maybe if we whack you on the head and render you unconscious, you may labour easily and birth quickly" I said this jokingly to a labouring mom from my childbirth class. She had been in 'labour' for more than 24 hours, leaking periodically, having contractions that were rhythmic and yet technically completely closed. She had done classes and prepared herself with information and skills to have a good birth experience. She understood everything that was going on with her. Oh yes! I did say she was prepared.
Just as pain in birth is subjective, so is childbirth preparation. All that information and practice, question - answers and support. Yet many a times well prepared moms' have slow long labours for no apparent reason at all. Days of 'labouring', contractions, pain, interventions and assistance, exhaustion and then ending up with C section for Faliure To Progress. What is it that makes some cervix open up more easily than others?
A recent birth I supported was going in the scary but much often tread road... long hard labour and extremely slow progress.
Day one began with leaking and contractions... mom did relaxation and breathing and when she felt that now it was strong to pull her out of the relaxed state, she went to the hospital. Doctor took a look and sent her back home.
Day two, contraction continued and she was back again. When I met her late Sunday morning and we talked about the virtue of relaxation and being patient. She hadn't even begun to efface. The doctor wanted to send her back yet again, but she was now throwing up. Sunday night, 48 hours after leaking began, she agreed to be augmented. The contractions moved from good to pretty good. All day she had used warm showers to relax and she really wanted to sink in a tub of warm water. We decided to do so, not just for the comfort but also she because she had her heart set on it. Warm water helped her... physically and mentally for a while and in a few hours she was anxious and needed affirmation that things were progressing. So another internal check told us that she was fully effaced. This was at 4 am. We all reinforced the fact that this was good... it was great progress. That buoyed her spirit for a bit but in the next four hours... she was at that 'time vs. progress' anxious phase again.
She had begun to bear down at the peak of her contractions by now. 8 am another check told us she was 4 cms. I thought she was doing great, but she did not think so. There was a bag of waters intact over the baby's head, despite the leaking. The anxiety moved to desperation...by 9 am she was talking of C section. I talked to her, and she listened and nodded her head while I counted of all the reasons that said she was doing well... but as the next contraction came she was back to C section. At 9:30 she was still 4 cms. She was now sure she did not want to go on... It was probably hard for her husband to say what he wanted. He was not the one in labour, so he said the only thing he could. He would support her in whatever she wanted.
It was really difficult for me, since I knew she could do this. I just knew, but it was not about my gut feeling... it was about what she was feeling in and out of the labour. This was not the time or the place to convince her otherwise. However, after a small discussion between contractions she chose to go with an epidural. She looked at me, and I smiled and said I would support her through it.
Just as the epidural kicked in she fell asleep and so much so that I had to check if the doctor had given her sedatives.. but no. An hour later, she woke up, she was able to feel some rectal pressure and another check told us that she was 6 cms. She was pain free, she had a sense of the contractions with the rectal pressure and she still was breathing through the contractions. Her eyes checked the clock often and I could feel the mind turn numbers round. Every now and then she would say why her body was not working or why the baby was not coming. The rectal pressure increased and she began to bear down. The baby's heart tones sounded slow and a fetal monitor was put on. The heart rates kept falling and at one point it dropped sharply and stayed low. It was 2 pm now and as the doctor checked she was still at 6 cms. As the heart rate slipped to 75 bpm there was a buzz about C section. This was goint to be another of those FTP.
The OT was prepared and the anesthesiologist was called.
In the last 5 years, I have seen this happen far too many times. The next contraction, I told her to pant and not bear down even when the pressure was there... the heart rate stayed steady. And then another contraction, and then another. I ran down to the doctors' office and asked her if we could get an hour.... one hour. She said yes, BUT, the heart rate should not go any lower than 110.
Back in the room I looked at this mom in the eye, raised my voice from soft suggestion to firm instruction, I told her to forget the clock, the monitor and the pressure and every contraction she would follow my breathing. One hour, she and I, alone in that room... I talked, she listened, and we blew and panted through every single contraction. The doctor would come in periodically and check the fetal heart rate monitor. her husband came in and slipped out quietly. Her mom sitting outside knew that this was going to surgery. One hour, I led and she followed and the beeping monitor was reassuring and we heard strong beat of the baby's heart. Past 3 pm, after the 'hour' was up, the doctor checked again, she was fully dilated. A beautiful baby boy was born at 3:59pm.
She was one of my Hypnobirthing mom... what worked for us that last hour was that we had done relaxation many times in class. She responded to my voice by sinking into a trance like zone. At one point i think I dozed off as well....So I did not whack her.. but close enough.
Some important things
Each time she was mentally relaxed... getting into the pool, first sign of progress, sleeping after the epidural and finally relaxation with my instructions.. she progressed
What does childbirth preparation really mean.. infomation?!? Does all that information make it any more easier for us to face labour? Or is there something else too... What is it that allows us to let go, give up our need to be control, to sink deeper to a subconsious level that actually believes in birth...trust, faith support.
Talking of support... motivating her, leading her, pushing her... sometimes all three. and sometimes the 'whack on the head'.