Sunday, April 4, 2010

Reassurance to Eliminate the Fear

I have had the opportunity to teach labor an delivery to several couples over the last week and one concept rings true no matter what the concerns, who is asking or where a couple is delivering. "What's it going to be like?" Well, what we know for certain is that every pregnancy and labor and delivery is going to be different. Just like the couple and the individuals involved. There are, of course, certain "givens", like one way or another the pregnancy won't go on forever ( the way women think by 38 weeks )and that it makes a world of difference to at least have an inkling of the process, as it is "supposed" to happen for the reassurance that we all crave. Nothing is as terrifying as not knowing how it is going to be. Fear of the the unknown is enough to stop most people in their tracks and a woman about to face labor and delivery CAN'T be stopped, no matter how much she is afraid because she doesn't know what's going to happen.

So the goal is to get everyone up to speed on the process. To combat fear of the unknown and provide the reassurance necessary to let the process evolve. There is supposed to be a logical progression and just knowing what that is about really cuts down on the fear factor.

So labor starts with contractions almost ninety percent of time. There is a big difference between Braxton- Hicks and "real" labor contractions. Real labor contractions do not "go away" and there is no way to manipulate them away ( like Braxton-Hicks ) or no one would be born. Occasionally, the bag of membranes ruptures and it can be a trickle or a gush. Amniotic fluid should be clear and odorless and if it isn't, contact your provider and be prepared to go to the hospital.If your "water breaks" it doesn't mean that the baby is going to rush right out and often there are NO contractions with this rupture. So call your doctor for the protocols. Labor is mucous-filled and gushy and there may blood. But not more than menstrual period, so again, contact your provider and be prepared to go to the hospital if you are not sure if this bloody discharge is more than it should be.

When you can "see" that the contractions are establishing a regular rate and rhythm and do that they do that for more than an hour or so, crank it up. Use gravity to help move that baby down into your pelvis and get it out of there. As the uterus contracts ( big and hard in your belly ) and the baby is forced to get its head deep down on the cervix, it enables ( with the contractions )the cervix to flatten out and dilate, so the baby can get out. It's a process; it takes time and work ( hence, labor )and can be supported with comfort measures and fluids and gravity. It is helpful to remember to empty your bladder and also your bowels.

You must breathe, in order to provide the baby with oxygen. So your provider will instruct you that you should go to the hospital when you can't talk ( not breathing ) through a contraction or if the contractions are closer than five minutes ( for first babies ) apart. From the start of one contraction to the start of the next, including the intervals between them. The baby should and will move during labor. If you can't feel the baby moving: go to the hospital.

I support a technique for you to focus on the labor contractions and to NOT focus on the labor when you aren't contracting. There are several ways to accomplish, this so you aren't wasting energy waiting for the next contraction. Contractions don't last very long ( maybe a minute or a little longer ) but the time between contractions can be long and tedious if you are waiting for the next one. The idea is to be supportive of the contractions so you let your body do the work its meant to do. And then you are a lot closer to holding the baby and not laboring any more.

The process will evolve, whether you are afraid or not. But knowing what the process is all about is aimed to provide reassurance so you will have less fear, more confidence in yourself and your labor partner and more control over how your "ideal" labor should progress. When we know what to anticipate and how it's "supposed" to be, we are better able to manage this unbelievable experience and be satisfied with letting nature take its course. Everyone wants to know what to expect and when we do, we aren't quite so afraid. That's the goal.