a birth story.

I want this whole post to be right, to accurately portray our birth story. Jackson’s birth story. Monday I was having plenty of contractions. Some “painful,” some just annoying, and hence I was annoyed. So I cleaned. I walked. I … Continue reading

37 weeks. and a “birth plan”

Birth Plans. Even hearing the phrase makes me giggle. Smirk. Plans and babies. The fact that I’m still pregnant and Mr.Muffin hasn’t purposely chosen to go against my “plan,” my schedule, is a miracle.  I wrote a birth plan before I got pregnant. A long time ago, when we were still living in Mitchell, I was still an OB nurse, and we were still oblivious to PCOS. It is truly what I would like in my perfect birthing situation… it is also a total spoof on “real” birth plans. I have tweaked it since then, but it still holds the same core values.

When you work in labor and delivery you learn, quickly, that the “plan” is to have a breathing, pink, heart-beating baby.  The “no Pitocin, don’t augment me, I want the whole town in the room, no IV fluids, skin-to-skin, baby can’t ever leave my side” crap goes by the wayside quickly if your baby isn’t healthy. People are TOTALLY entitled to have preferences. You are entitled to not have your baby vaccinated (but please, don’t ask me my opinion), to refuse pain medication, to have the lights dimmed, or to have your great-great grandmother in the room. Whatever, as long as the nurses and physicians can keep you and your baby safe, most anything can be kosher.  (God help me, I’m speaking in the tense of a current L&D nurse, I miss that job so much!). What I learned was also, when things look scary or dangerous, the nurse will escort grandma to the waiting room.  The physician will do everything possible to make sure you don’t bleed out on the table. The pediatrician will whisk your baby away to make sure he starts breathing.  And… much to your birth plan’s surprise, you won’t care.  You’ll just want things to be okay.

So, in honor of being “full term” here is my birth plan:

birthplan1birthplan2

happy full-term week to us. anytime now, mr.muffin. anytime.

epidurals

ah, the great divide. the epidural.

As I am quickly approaching my estimated date of confinement, my due date, I thought I would share some thoughts on pain management during childbirth.

An epidural is simply analgesia that is continuously injected into the epidural space, near your spinal cord, via a very small, flexible tube.  This medication, when placed correctly into the epidural space, numbs the area of injection and down, working mostly on a gravity basis, and can be stopped and pulled out at basically any time. This definition is mine, not a book’s, not a website’s, but how I know an epidural works.epidural

In my experience as a nurse, the “best” epidurals leave you with the pressure sensation (the medication CANNOT take that away people, no matter how many times you press that button), will numb the pain, and will still allow you some ability to move your lower half independently.  There are, of course, MANY variations to the outcome of a successful epidural – from great lower half movement, to complete “dead weight,” from still feeling pain, to absolutely no idea you even have legs because they are so numb. Sometimes the recipient of the epidural (or their significant others and family), doesn’t understand that an epidural is not a super-duper scientific thing – that the biggest factor is typically the patient’s anatomy and physiological response to the medication, NOT how the anesthesiologist put it in there.  While there is some room for adjustment or the option of replacement, typically, what you get is what you get – in my humble experience, of course. I am not an anesthesiologist. Or CRNA. Just a lowly nurse.

 

Anyway. What you are all dying to know. Am I planning on getting an epidural? Let’s explore that question.

I am not planning on not getting an epidural. Which means I am undecided. Which means, I will probably get an epidural. Here’s why:

  1. I am NOT afraid of getting an epidural. I am much more afraid of a cesarean.  Or hemorrhaging.  Or my baby coming early. An epidural, like any medical procedure, is generally safe. There are risks with everything, including an epidural. But childbirth is risky despite the epidural factor. Walking across the street is risky, too. That’s life. (Thank you Dr.VanRatface who drilled that into my head). Sometimes modern medicine is awesome. Epidurals are proof.
  2. I am not my grandmother.  My cousin, among many women, was quoted saying, “my grandma had babies without an epidural, and so can I.” And she was right, and she did it. YAY. Same baby, either way.  Here’s the thing… I’m pretty certain my grandfather has also had teeth pulled without anesthetic. Because he was a poor kid. And that’s just how they did it. Not because he was “tough” or really wanted to experience pain, or because rotten teeth are a “natural experience.” No, it was because it was pull it or become septic from a bad tooth.  Almost anything can be done without analgesia, but WHY in the world would you choose pain? Same baby, people, you get the same baby. They are not cuter or smarter based on your level of pain. Also, I’m pretty sure my grandmother delivered more than one baby in a state of twilight sleep. Which is analgesia, and much more dangerous that an epidural. Just sayin’
  3. This is my first baby. Let’s just say, this little boy will be plowing a new path. Those tissues are inexperienced to childbirth, they aren’t going to like it.  And a perineal repair, while it can be numbed by lidocaine, has appeared to me to be much less devastating if you have an epidural infusion running, numbing those tissues, and preventing the extra swelling that happens when you have to shoot those tissues up with lido… it’s not cute. I’ve seen women scramble towards the head of the bead, away from the doctor, with the lido injection after delivering a baby without pain medication.  That should tell you something about how much fun it is to get needles in your va-jay-jay after delivering a baby.
  4. Plus, the first labor is typically the longest. While I can endure pain in the short-term okay (I choose running for a hobby for goodness sake), I will wimp out after a few hours. I just will. I know and accept this about myself. Not to mention, for the sake of my husband, I don’t want to be a b*tch for a million hours. I want to look back and say, “yep, it hurt. yep, I got an epidural. yep, life was MUCH better after that.”
  5. IV pain meds are dangerous. Ok, maybe not dangerous, but much more touchy and much less effective. AND for those of you who choose to not get an epidural because “I don’t want my baby to get the medicine.” HAHA I say. Epidural medication does not go into the mother’s blood stream, so it sure as hell doesn’t go into the baby’s. Ask a doctor. They’ll tell you the same thing.  However, when you ask for IV pain meds, which are narcotics, they do go to you AND your baby. And stay in your body for a while. And make women (and the baby) feel sleepy or nauseous or dizzy. Not necessarily a perk in labor. Epidurals don’t do that. And you may need more than one dose of IV meds. And an epidural only targets the lower half of the body, you know, the part that hurts.  Perks!
  6. Just in case we need a C-section:  If we need to do a STAT, emergency cesarean, and I already have an epidural in place, there is a better chance they can “dose up” my epidural with stronger medicine and I won’t need general anesthesia. So I’ll get to be awake and hear the first cry. Of course, no guarantees, but it does help my chances of being awake in that extenuating circumstance. Let’s hope this reason doesn’t matter though.
  7. Breastfeeding might go better: because there is a good chance I can nap a little with an epidural before I need to push, so I’ll be (a little) less exhausted, and more focused on breastfeeding. It’s going to be clumsy and awkward not matter what, but epidurals don’t  make breastfeeding worse.
  8. I could do it, but I doubt I want to. Can I have a baby without an epidural? Yep! Do I want to? I doubt it.  Maybe I’ll surprise myself and handle things well. Maybe I’ll be dilated to 6 cms when I arrive at the hospital and know that I can gut out the last 4. And pushing. And a perineal repair (I’m obviously counting on one of those, whether by tearing or an epis).  BUT, because I am on the fence, I’ll probably ask for an epidural. Almost EVERY wishy-washy patient I cared for eventually asked for an epidural.  If you are planning on not getting one, and delivering in a place where they are available, DO NOT BE WISHY-WASHY. You have to be convinced 100% you don’t want it. And be concrete.  The nurses don’t like watching you hurt.  Your hubby does not like watching you hurt. And believe it or not, the doctors don’t typically care either way, but they DO seem to hate coming into a room of psychotic screaming to deliver a baby.  So, if you adamantly don’t want an epidural, GOOD FOR YOU, but prepare yourself. The moment you cave a little, everyone is going to willingly put you out of your misery and let you get an epidural.

This whole post is my opinion, based on my experiences.  Everyone is allowed to have  their own opinions, make their own choices. If you don’t want an epidural, for whatever (crazy) reason, it’s absolutely okay. And cool with me. I was always super-duper impressed and inspired by those women who delivered without an epidural on purpose (I would come out of those rooms and be all, “YEAH! I don’t need an epidural!!”). But realistically, I’ll probably get one.  And that’s okay, too.  I won’t be any less of a woman. My baby won’t change from the little guy he is meant to be.  Life is made of choices, risks, and all sorts of stuff we can’t control.  That’s how it is. My whole life path will doubtfully be changed based on getting an epidural or not for this delivery.  So, I’m not going to worry about it (very much).