General questions about labor/delivery

Mary G, mother of three (1 section, 2 VBACs), responds:

1- Does everyone have an IV or is one only given in certain circumstances?
Had one with #1, would never go there again. You need to be free to
move around to cope properly, and an IV is very restrictive and
uncomfortable when you are in labour. You can DRINK fluids. I would
say no to a routine one. If something happens that requires one, they
can get one in and running in minutes.

2- Do they hook you up to a catheter, or only in certain circumstances (such
as c-section)..this is a paranoia of mine ever since they made me have one
for a vaginal ultrasound in the ER one time...it was SO miserable, having
the tube up the urethra, ugh...I found out later it was not necessary and
not recommended for no good reason!!

The only reason you need a catheter is if you can't pee on your own.
This sometimes happens with an epidural (i.e. you can't feel and relax
properly to pee), or if baby is in a position to block your ureter and
a full bladder is keeping baby from coming down. Use the toilet if you
can. Stay mobile. It helps both with coping and with your mental
state. The more tubes you have in and on you, the more miserable you
are going to be.

3- At what point do they usually put an epidural in if you are going to have
one? I watched a woman on TLC's Baby STory scream and cry in agony until
they thought it was the right time for the epidural. Yikes. (I have not
decided whether natural or epidural is for me. I venture to say I have had
such bad female pain/cramps before that labor can't be much more painful
although I think it can be more uncomfortable, with pressure etc)

Women make noise in labour. This does not mean the pain of labour is
horrible and unmanagable. Its not like other pain - it doesn't mean
you are in trouble, hurt, dying or anything else scary that pain
usually means. It is like being in a fire that doesn't burn you - it
means nothing but that your body is doing its thing and your baby is
coming. It is pain with purpose, and with a defined end. It stops as
soon as baby is out. I've had two babies without pain meds and I made
noises like a chicken being run over by a freight train, but I would
never have an epidural again - I did fine with the right support. No
matter what, you don't want to have an epidural too early in the game
since it means you are stuck in bed with a bunch of tubes hanging off
you and you will feel like a victim. Most docs don't want to do them
too early, since an epidural can slow down your progress. Your best
plan is to have lots of ideas for helping yourself cope. Hire a doula.
Use a bathtub. Plan to walk the halls. Have lots of ideas other than
just have drugs. Even if you want an epidural, there may be a period
of time before you can get one, so you need some alteratives in your
tool box. They also don't always "take" properly. And yet another
reason to try and avoid one is that they impede your ability to push.
If you can't change positions during pushing and can't feel whats
going on, your ability to get baby out is reduced. Many a "stuck" baby
can be unstuck with mom flipping onto her side or all fours. Being
able to push well also helps you avoid forceps and suction to get baby
out, which also reduces your odds of episiotomy. Incidentally,
episiotomy is almost never really necessary. Say NO to a routine one.

4- When do you need to go to the hospital, when your contractions are how
far apart?

You can ask your doc, but by personal experience, particularly with a
first labour....don't go too soon. You want to wait until they are
quite close together and you can't talk through them. If you get there
too soon, you may be there for hours and hours and hours and the
longer you are there, the more likely you are to get messed with in
ways that make you miserable. Many hospitals have one size fits all
protocols and expect you to make progress to their timetable - so you
may be doing just fine, and they will be pushing you to have pitocin,
break your water, have IVs, have monitors, drugs, heaven knows what
else that you can avoid by not getting there until things are well
advanced. Besides, being at home is way more comfortable. You can hang
out in your tub, have something to eat, have a nap. A doula really is
a good plan, since you can have one come to your home to help you stay
home longer. My second baby (a VBAC), I arrived at hospital just about
ready to push, and that was great. Much better than hanging around the
hospital for 30 plus hours like I did the first time.

5- After delivery, do they continue to give you pain meds? i really have no
idea...it doesn't seem like a good idea if you are going to try breast
feeding- what is the usual procedure? For most, are pain meds after delivery
even necessary even if someone wanted an epidural for pain relief during?

Depends. If you say NO to episiotomy and haven't had a section, you
probably won't need drugs. The women who are most uncomfortable post
partum are those with a nether region full of stitches. If you can
avoid that, you will be a bit sore, but nothing you can't deal with.
With my third baby, all I had a was a skid mark that needed one or two
stitches, and I was quite comfortable. You do get the odd blaster
after pain in the first days, particularly as you start nursing, but
they aren't constant, and you can deal with them.

6- Last question...has anyone had bad experiences with epidurals? Has anyone
thought it to be unpleasant, freaky, etc?

Honest to god, I hated it - I really hated not being able to move
around or feel my legs. I had to have a catheter and an IV. I ended up
with an internal monitor. It was just awful. The reason I ended up
with one my first time out was because I went to hospital too soon. I
couldn't rest properly, I was nervous, staff kept coming and going as
shifts changed, they wouldn't let me eat. I got totally strung out and
exhausted and at the end of my rope - and they also started pushing
interventions like pitocin, monitors, IVs etc. Finally, I was so
tired, I was just beyond being able to manage, and I had an epidural
(and my husband was in equally awful shape after 2 nights of stress
and no sleep - not exactly a happy situation for him). Within a short
time of having the epidural, my blood pressure sewered out (not
uncommon), and I ended up in the OR having a section. So...my section
was ultimately iatragenic - the need for it came as a direct result of
the way my labour was "managed" by the hospital. It was not needed
because my body failed. It was a direct result of stuff that got done
to me that was not medically necessary. The next two times, I had
midwives to act as doulas, although they were both hospital births,
and it was a whole other planet. No interventions, no drugs, no
problem and a much, much better experience. I did fine.

Don't be passive about your birth experience i.e. don't leave it to
the hospital and medical staff alone. Don't underestimate the
intimidation factor and how the hospital machinery will steamroller
over you. You will be vunerable. Set the scene for a positive
experience. Study after study has shown that the key to a good birth
experience and avoiding interventions and drugs is good labour
support. Labour nurses can't give you the kind of one on one support
you need - they work limited shifts and often have several patients at
once, so they pop in and out - they can't stay with you all the time.
They also don't work for YOU - they work for the hospital and the
doctor. Your husband/partner will also need support - this will be a
challenge for him as well as you. His real job is to hold your hand
and love you and ride the roller coaster with you. He will be nervous
himself and under stress, so expecting him to be in charge of all
comfort measures, support, running interference, providing ideas,
knowing all kinds of stuff about birth and labour etc. etc. is just
too much to expect (i.e. my husband was so tired the first time and so
scared, that he didn't know what to think when the doc pushed various
ideas - he felt like he was responsible for everything under the sun
and it wasn't a happy experience for him). The best bet is to get
yourself a knowledgable doula or midwife who KNOWS both of you, and
can first come to your house to help you cope, go with you to
hospital, and stay with you through the labour, to help both of you
cope. Made a huge, huge difference for us. I think if I'd had a doula
or midwife first go round, I would never had had the section.

Mary G.

"Vicki S" wrote in message
...
... (No afterpains with a first baby.) ...

Wow. Speak for yourself! I'm happy for you, lucky you, and all that,
but this is not true for everyone. I took a few painkillers after my
son was born. I had afterpains, especially during breastfeeding. It
was manageable, but it was real.

That aside, I can't imagine that most women don't experience *some*
post-partum perineal discomfort, even if they have an intact perineum (and,
frankly, most women don't!). The afterpains were certainly much worse after
my second and third babies than my first, but my nether regions were pretty
sore as well. As it happens, I did have an episiotomy or tear every time,
though the tears were less painful than the episiotomy and healed more
quickly. But either way, I didn't consider the post-partum pain meds as
something intended solely to treat *afterpains*, but to treat the discomfort
associated with stretched and torn tissue as well.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [20mo] mom)

This week's special at the English Language Butcher Shop:
"Rejuvinate your skin." -- Hydroderm ad

Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

J wrote:

I have a few miscellaneous questions about delivery in a hospital with ob's
(in the u.s....)

1- Does everyone have an IV or is one only given in certain circumstances?


Depends on policy. For a normal, unmedicated labor it
isn't necessary, but in some places you'll have to fight tooth
and nail to avoid an IV. If you go without an IV (my preference)
remember that you have to at least drink frequently and probably
eat a bit here and there too in order to maintain hydration and
nutrition during labor. Getting dehydrated is bad.


2- Do they hook you up to a catheter, or only in certain circumstances (such
as c-section)..this is a paranoia of mine ever since they made me have one
for a vaginal ultrasound in the ER one time...it was SO miserable, having
the tube up the urethra, ugh...I found out later it was not necessary and
not recommended for no good reason!!


If you have an epidural, you will probably have a catheter.
If you don't pee frequently enough, you may also get to a point
where it's difficult to pee and the full bladder is impeding
your labor. In that case, they might also catheterize you
in order to get the full bladder out of the way. Other than
that, there shouldn't be any need for a catheter in a normal
labor.


3- At what point do they usually put an epidural in if you are going to have
one? I watched a woman on TLC's Baby STory scream and cry in agony until
they thought it was the right time for the epidural. Yikes. (I have not
decided whether natural or epidural is for me. I venture to say I have had
such bad female pain/cramps before that labor can't be much more painful
although I think it can be more uncomfortable, with pressure etc)


Oh, please. Don't go by what you see on that show.
If you have an epidural, you will be required to have an IV
and a catheter. If you go without an epidural, you can
avoid that plus the other possible complications of an
epidural. If the pain gets the better of you, by all means,
choose an epidural if it's a good choice for your
situation, but why would you choose one in advance? If you
think you'd like to go unmedicated, you will likely need to
do more than just decide you're not going to have an epidural.
There are things you can do to make it much easier for you
to deal with labor pain, but it helps a lot to have the
right knowledge and support to make it happen. A doula can
help immensely, as hospital staff often have very little
experience supporting women through unmedicated childbirth.


4- When do you need to go to the hospital, when your contractions are how
far apart?


It depends on a lot of factors. Many say to go with
they're no more than five minutes apart, lasting longer than a
minute, and getting longer, stronger, and closer together.
However, that gets some women there too early and a very
few there too late (rarely too late for a first labor, though).
If you have a doula, she can come to your home and help you
decide in the moment when it's time to go to the hospital.


5- After delivery, do they continue to give you pain meds? i really have no
idea...it doesn't seem like a good idea if you are going to try breast
feeding- what is the usual procedure? For most, are pain meds after delivery
even necessary even if someone wanted an epidural for pain relief during?


It depends. For a normal, vaginal birth you probably
won't need much, if anything, in the way of pain meds
afterwards. Some might use Tylenol for afterpains, but
those usually aren't bad with a first baby.


6- Last question...has anyone had bad experiences with epidurals? Has anyone
thought it to be unpleasant, freaky, etc? I find it hard to believe that
epidurals are soooooo wonderful like people are telling me although I can
understand how some would want one; I might. My sister-in-law in particular
LIKED hers- she said it was warmth washing up over you like a warm bath and
then you couldn't feel your legs. To me, that sounds unpleasant, I like to
be able to feel my limbs!


Yes, there are people who have bad experiences with
them, though serious complications are fortunately rare
(they do exist, though). About 80 percent of the time they
don't work all the way, either (anything from not working
at all to spotty coverage). They can slow down labor.
They also limit your mobility, which can sometimes come
in handy while laboring (changing positions can be
effective for many difficulties).
Personally, I loathe the thought of losing control
of my limbs and didn't opt for an epidural in any of my
three labors. On the other hand, they are often quite
effective compared to the alternatives and many people
like them. Personally, my recommendation is to plan to
go without and give it your best shot, but if you get to
the point that you need one, it'll be there. No need to
decide in advance. Just learn about the pros and cons so
that when and if the time comes, you'll be able to weigh
the risks and benefits for your personal situation.

Best wishes,
Ericka

"Vicki S" wrote in message
...
... (No afterpains with a first baby.) ...

Wow. Speak for yourself! I'm happy for you, lucky you, and all that,
but this is not true for everyone. I took a few painkillers after my
son was born. I had afterpains, especially during breastfeeding. It
was manageable, but it was real.


I had afterpains with a c-section and no breastfeeding. Let me just say
"Holy moly!" - lol. I was taking Motrin anyway (for my boob pain) and the
afterpains were still wowie.

--
Sophie -
#4 due July 18, 2004

I watched a woman on TLC's Baby STory


Well stop watching that show. Seriously, I was glad I didn't discover that
show till *after* I had my first. I personally don't think it shows child
birth in a good light at all. Occasionally (and I haven't watched it in
*yrs*) they show a good birth (at home, no freaking out, etc...). And
absolutely don't watch TLC's Maternity Ward.

--
Sophie -
#4 due July 18, 2004

"Sophie" wrote in message
...
I watched a woman on TLC's Baby STory


Well stop watching that show. Seriously, I was glad I didn't discover
that
show till *after* I had my first. I personally don't think it shows child
birth in a good light at all. Occasionally (and I haven't watched it in
*yrs*) they show a good birth (at home, no freaking out, etc...). And
absolutely don't watch TLC's Maternity Ward.

--
Sophie -
#4 due July 18, 2004



Oh, I love watching Birth Day on Discovery Health -- it's a riot (if you
have already accepted that obstetricians screw up normal birth) -- "Becky
Jones is having a cesarean today because her baby is too big ... Welcome
Jayden, 7 pounds 11 ounces!"

-- Dagny
#1 10/17/03

Oh, I love watching Birth Day on Discovery Health -- it's a riot (if you
have already accepted that obstetricians screw up normal birth) -- "Becky
Jones is having a cesarean today because her baby is too big ... Welcome
Jayden, 7 pounds 11 ounces!"

-- Dagny
#1 10/17/03


Lol!

I don't know. All the screaming and everything with ABS bothers me. The
home births and water births are neat though.

I don't understand Maternity Ward though. It's certainly not entertaining
and I can't even see how it's educational.

I would like to see Birth Day but I don't get the channel it's on

Ericka Kammerer wrote:
J wrote:
I have a few miscellaneous questions about delivery in a hospital with ob's
(in the u.s....)
1- Does everyone have an IV or is one only given in certain circumstances?
Depends on policy. For a normal, unmedicated labor it
isn't necessary, but in some places you'll have to fight tooth
and nail to avoid an IV. If you go without an IV (my preference)
remember that you have to at least drink frequently and probably
eat a bit here and there too in order to maintain hydration and
nutrition during labor. Getting dehydrated is bad.

You should be able to request a heplock at least, if they won't budge
on the IV. Then they have vein access, but you don't have this
cumbersome IV and pole and tubing to deal with when you want to change
position, walk, get in the shower, etc. Drinking juice/water between
EACH contraction helps a lot, as does having a partner who sends you
to pee every hour (think of it as a position change

2- Do they hook you up to a catheter, or only in certain circumstances (such
as c-section)..this is a paranoia of mine ever since they made me have one
for a vaginal ultrasound in the ER one time...it was SO miserable, having
the tube up the urethra, ugh...I found out later it was not necessary and
not recommended for no good reason!!

If you have an epidural, you will probably have a catheter.
If you don't pee frequently enough, you may also get to a point
where it's difficult to pee and the full bladder is impeding
your labor. In that case, they might also catheterize you
in order to get the full bladder out of the way. Other than
that, there shouldn't be any need for a catheter in a normal
labor.

I was able to hold off on the epidural in part because the nurse I did
NOT like was just so gleeful over getting a catheter in me and an
internal monitor screwed into the baby's scalp (women on an epidural
are easier for the nurses, less work). Right. I sent everyone away
and was 9 cm pretty quickly, then ready to push.

3- At what point do they usually put an epidural in if you are going to have
one? I watched a woman on TLC's Baby STory scream and cry in agony until
they thought it was the right time for the epidural. Yikes. (I have not
decided whether natural or epidural is for me. I venture to say I have had
such bad female pain/cramps before that labor can't be much more painful
although I think it can be more uncomfortable, with pressure etc)

Oh, please. Don't go by what you see on that show.

LOL! I'm so glad I don't watch them! Well, watch them if you like
them, but first read some books like Sear's Birth Book, then you'll
start seeing the women crying in agony are being forced to stay on the
bed, with an IV and they aren't walking around, or trying all fours or
other positions! It can open your eyes to just what is problematics
about an over medicalized birth (if only they could stick to
interventions when needed, sigh). My labor was really managable in
the shower or sitting backwards on the chair. The only time I was
screaming was when they made me stay on the bed to 'get a good strip'
which meant the nurse hooked me up and left, never taking it off
because it didn't record well -- AND not taking the time to hand
monitor for just one or two contractions that are sufficient. I wrote
that into my birth plan this time around. If the monitor doesn't pick
up the baby's heartrate during the 2 required contractions for
intermittant monitoring, then the nurse must hand monitor me.

Plus, if you go into labor planning on the epidural, you may not take
as much time to think about other means of pain management and so
until you can get the epidural (they wait because epidurals will slow
down labor in a lot of cases, so they want you far enough along,
though most women seem to get pitocin no matter when they got the
epidural) you will be much more unhappy then with plans in place to
try positions you have practiced, things like that.

If you have an epidural, you will be required to have an IV
and a catheter. If you go without an epidural, you can
avoid that plus the other possible complications of an
epidural. If the pain gets the better of you, by all means,
choose an epidural if it's a good choice for your
situation, but why would you choose one in advance? If you
think you'd like to go unmedicated, you will likely need to
do more than just decide you're not going to have an epidural.
There are things you can do to make it much easier for you
to deal with labor pain, but it helps a lot to have the
right knowledge and support to make it happen. A doula can
help immensely, as hospital staff often have very little
experience supporting women through unmedicated childbirth.

Good points. My DH was *awesome* when ds#1's labor, though he was
really tired and didn't give me a lot of verbal encouragement. Extra
(trained!) people can make a difference and just having someone tell
you over and over that you are doing great, wonderful, can handle it,
did handle the last one and can handle this one, etc is HUGE. The
nurses won't spend a second more with you then they have to (even if
they could spend 15 minutes rubbing your back and telling you what a
great job you are doing, I found the attitude that they didn't want
to, plus they aren't trained to think about such things for pain
relief -- just epidurals).

4- When do you need to go to the hospital, when your contractions are how
far apart?

It depends on a lot of factors. Many say to go with
they're no more than five minutes apart, lasting longer than a
minute, and getting longer, stronger, and closer together.
However, that gets some women there too early and a very
few there too late (rarely too late for a first labor, though).
If you have a doula, she can come to your home and help you
decide in the moment when it's time to go to the hospital.

My contractions were *every* *two* *minutes* from the start, but 30-45
seconds! They weren't very strong at first and I felt quite perky, so
I wished we hadn't gone in so soon, rather when they felt strong or
harder to handle.

5- After delivery, do they continue to give you pain meds? i really have no
idea...it doesn't seem like a good idea if you are going to try breast
feeding- what is the usual procedure? For most, are pain meds after delivery
even necessary even if someone wanted an epidural for pain relief during?

It depends. For a normal, vaginal birth you probably
won't need much, if anything, in the way of pain meds
afterwards. Some might use Tylenol for afterpains, but
those usually aren't bad with a first baby.

I had a midwife -- no episiotomy. But I sure loved that latex glove
filled with ice!! My perineum was sore for a few days and I had a
'skid mark' that felt better with a squirt bottle of water when I used
the bathroom. I could walk around just fine about an hour after ds
was born and the shakes subsided.

6- Last question...has anyone had bad experiences with epidurals? Has anyone
thought it to be unpleasant, freaky, etc? I find it hard to believe that
epidurals are soooooo wonderful like people are telling me although I can
understand how some would want one; I might. My sister-in-law in particular
LIKED hers- she said it was warmth washing up over you like a warm bath and
then you couldn't feel your legs. To me, that sounds unpleasant, I like to
be able to feel my limbs!

Yes, there are people who have bad experiences with
them, though serious complications are fortunately rare
(they do exist, though). About 80 percent of the time they
don't work all the way, either (anything from not working
at all to spotty coverage). They can slow down labor.
They also limit your mobility, which can sometimes come
in handy while laboring (changing positions can be
effective for many difficulties).

Also, they can cause a fever in the mother or the baby, requiring
separation of the baby to the nursery for hours of observation and, of
course, worry. If you have a very long early labor, and are just too
tired to make it through transition, it can make a world of difference
but there are a lot of side effects and potentional complication (if
the pitocin doesn't keep labor moving along fast enough for the OB's
chart after you get one, it's c-section time).

Personally, I loathe the thought of losing control
of my limbs and didn't opt for an epidural in any of my
three labors. On the other hand, they are often quite
effective compared to the alternatives and many people
like them. Personally, my recommendation is to plan to
go without and give it your best shot, but if you get to
the point that you need one, it'll be there. No need to
decide in advance. Just learn about the pros and cons so
that when and if the time comes, you'll be able to weigh
the risks and benefits for your personal situation.

What she said! Check out your local library -- Sheila Kitzinger's
book and the Sears Birth book are great ways to get some additional
viewpoints on labor in a hospital.

Carolyn



--
Carolyn Fairman
http://www.stanford.edu/~cfairman/

Every hospital is different. you will have to ask your midwife or ob
specifically on what to expect.
where I work may not be like the hospital you are planning your birth at
iv are by no means mandatory. depending if you have any pre existing
conditions here are some of our reasons why you would need one. gbs+,
wanting an epidural, giddm, oxytocin induction or augmentation.
epidurals are a bit different here. people usually need to be around 3-4 cm
dilated (active) labour. they are not usually put in before that since
latent labour can last hours to days. given that there are some
circumstances they are given early for example (only a few off the top of my
head) someone who is being induced with oxytocin, twins, hellp syndrome,
Wolfe Parkinson white,
we never shut off our epidurals until after delivery and or the repair is
done. in saying all that they are great for pain control but the really do
extend your second stage of labour and may increase the risk of
intervention.
catheters are only given to those with epidurals or those having a
c/section.
first and most important stop watching the baby story it's an awful show. it
never gives you the whole picture and is very misleading. as far as the lady
screaming in agony and not getting her epidural until the staff thought it
was time. I can't answer that we don't know how dilated she was she may have
only been 1 cm or she might have been fully dilated and pushing and unable
to get one. she might have had a condition that prevented her from getting
one, or taken some sort of medication that will effect it somehow. like I
said never go by that. they never tell you whole story.
go to the hospital when your contractions are 3-5 mins apart lasting a
minute and you are unable to talk to them, or if you feel you are requiring
something for pain.
our procedure here for pain meds after delivery is a self medication program
we teach pt's. Advil and Tylenol usually around the clock for the first 24hr
then using at your discretion after that. if that's not enough then ask for
something stronger. i.e. Tylenol 3's or something stronger. unfortunately
after is not an indication for another epidural (hehe) despite what some
people think.
I have never seen a bad experience with an epidural. my suggestion is to
keep an open mind to the idea and get it if you need it. ask the
anaesthesiologist questions that's what they are there for. don't go into
this with a close mind saying I want no interventions plan for the
unexpected and go with the flow. it's ok to say wow this isn't what I
thought I need something for pain. but my to friends did it with nothing. so
what if they did that's them not you. so what if you need something, your
not the first and not the last. pain is perceptive to each person what isn't
painful to you maybe to me. remember we all get the same thing in the end
( a baby) no matter how we do it. Ask yourself is the journey more important
then the destination?

wrote:

5- After delivery, do they continue to give you pain meds? i really have no
idea...it doesn't seem like a good idea if you are going to try breast
feeding- what is the usual procedure? For most, are pain meds after delivery
even necessary even if someone wanted an epidural for pain relief during?

I had a C-section for one birth and a fairly difficult experience with the
other, so yes, pain meds were a very good idea as far as I was concerned. They
get to the baby in much smaller concentrations by breastfeeding than they would
in utero, so it didn't concern me to take them as long as needed.

Many women do have painful cramps as the uterus contracts down on itself after
birth, too, even if they have no particular perineal pain or swelling, so lots
of women will be taking ibuprofen or something.

By the way, ibuprofen is strictly contraindicated in the last trimester of
pregnancy due to an effect on fetal circulation (someone will be sure to have
the details if you actually want to know). After the baby is born, its
circulation has changed over to the regular kind, and ibuprofen is NOT a
problem during breastfeeding. Since it's much better for any kind of
cramping-type pain than Tylenol is, that's important to know.

--Helen