all posts, parentings/things about baby and kids, women's health

prepared childbirth: the skin plan

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I’m combining all my other blogs’ content to this site. Please bear with me as I post older content. 🙂

In April of 2018, my husband and I attended a 6-hour class on childbirth preparation. I’ll go into a few details about specifics we learned, though it is important to keep in mind, different hospitals and different OBs may have different practices than what we were told.

The whole view around labor now, is that modern medicine is more than capable of helping pregnant folk with the pain. The thing they can’t fix is if we get fatigued. Fatigue is the biggest predictor of if there will be a need for an unplanned Cesarian section because if we laboring women wear ourselves out before we are in the pushing stage, we won’t be able to physically get the baby out into the world. This becomes even more important to note when the pregnant mama-to-be is already battling eczema and it’s host of fatigue-induced symptoms like sleep deprivation.

The first topic the educator went into were ways to conserve energy, aka ways to relax. Physiologically and mentally, giving birth is draining. Mentally, there is pain, so she explained the options our specific hospital has to allow women to cope.

  • Analgesics – I can’t remember the specific names of the two that are put into the IVs but essentially, all of the analgesic options help take the edge off. They don’t make the pain of contractions disappear, but they chemically help to relax the muscles, which allows for us to perceive less pain. How it works is that it helps us waste less energy reacting to pain, decreasing how much we stiffen up from feeling pain or how we can’t relax between contractions. The two analgesics mentioned in the class do cross the placenta, and thus can affect the baby, so the educator advised that if we want these ones to request them before we are 9cm dilated so that there is more of a chance of it getting out of the baby’s system before the baby is born. Otherwise the baby will also get some of that chemical relaxation affect and may then score poorly on the APGAR test (because they will be unfocused and floppy). The third type of analgesic mentioned was nitrous oxide (aka NO, or that’s right, laughing gas!). It does not cross the placenta nor affect the baby but its catch is that only the mom herself can administer this drug. She has to be able to hold the mask to her own face and breathe and then remove it on her own (for legal reasons). Now how do these chemicals affect the skin of someone with eczema?
  • Epidurals – There are two types used: the local or the full. The local (which has gotten the misleading name of “the walking epidural”) numbs the woman’s body from basically her chest to her groin. Though theoretically her legs would still have feeling, if you can’t feel your abdominals or other stabilizing core muscles, you really can’t walk. The full epidural numbs all the way down to the feet, and it is administered when you have to go into an unplanned C-section. When you get a local epidural you have to go in to the C-position on the bed (or that position we see women giving birth in in movies all the time), and you will have to be cued of when to push because the epidural numbs you from feeling any pain of the contractions at all. Supposedly you will still feel something, but most often it is described as a distant pressure.

The rub with all these options for medical pain killers (analgesics and epidurals) is that they can have the unintended consequence of slowing down the labor. If they cause you to be too relaxed, particularly your uterus, you run the risk of the doctor then needing to give you something to “get you back on track”. What this means is that they will add pitocin (a manmade version of oxytocin) to stimulate stronger contractions. The catch-22 of pitocin is that, unlike oxytocin which is made naturally by your body and will gradually increase your contractions to some extent, pitocin is more of a 0-to-60-in-no-time kind of drug, and often times women report that it makes contractions much more painful. It definitely did in my case.

If you have a scheduled C-section, you will be given a spinal tap, which is when the medication is administered so it goes into your spinal fluid. You will then lay down and a tarp will cover you from the chest down (though you can request a see-through one if you want to watch the procedure) and your arms will be tied in a T shape so that one can have constantly blood pressure monitoring, and the other can have the IV in place. Afterwards, depending on the hospital, you may be able to have the baby wrapped up against your body after they have taken the baby for cleaning and screenings, or you can have your partner do skin-to-skin contact if you are too tired/out of it.

Which brings me back to mentioning induction. A hospital can have a few reasons to induce, and I think it can vary by hospital/practice. One reason is if your baby may be late. Apparently, it is common to induce around week 39 now because it allows for an extra week in utero so that if the due date was off by 7 days, you are at least on week 38 (week 38-42 is deemed the safe range for a baby to be born and be totally developed but also still get enough nutrients from the placenta).

Fun fact: did you know they figure out the age of the baby, and whether they were right or not at their predictions, by the placenta? Apparently, it ages and you can figure out when it formed by its coloration!).

Back to induction; so what normally causes labor to start? Scientists and doctors have no idea what triggers the chemical to be released at that specific time, but they do know that prostaglandin is the chemical that sets it all in motion. This is because prostaglandin cause the cervix to soften. Many women when seeing a OB/GYN probably learned that the cervix feels like “the cartilage at the tip of your nose” or something like that. Well when we are going into labor, we want it to soften so that it can then efface (or thin out) and make way for the baby. So first, if you need to be induced, they will add prostaglandin to you (either via an IV or through a suppository inserted in your vagina that has to dissolve). If that works and your cervix softens, then you are given pitocin to make the uterus contract. Then if all goes well, you’ll quickly ramp up in contractions and soon progress to the pushing stage.

So what happens during this first stage, the contractions? Well, like I mentioned before, the focus is on controlling pain so that you don’t tire yourself out. That’s really it. As your body works on the contractions and starts to dilate your cervix to 10 cm, you aren’t really an active participant, so you just have to find ways to bear the pain/discomfort without wasting your energy staying balled up or tiring yourself out. Unmedicated suggestions they mention are (and again this depends on the hospital you are at) using a hospital bath/whirlpool to relax the muscles, sitting on a PT ball, moving around and changing position (if you didn’t get an epidural), taking deep breathing (always need to keep breathing and never hold your breathe- it makes you tight/wastes energy), visualizing something calming, etc. The educator also mentioned how if you are “stalling” or your contractions aren’t going at the speed the doctor thinks they should, and he/she feels they may need to give you pitocin, that you should request an extra 30 minutes and do everything from listen to music, 6th grade slow dancing with your partner, cuddle, kiss, or get up and move around (if you didn’t have an epidural). This is because all these actions can help release more oxytocin, which helps force those contractions to continue.

Then when you’ve finally reached 10 cm dilation, the pushing stage can begin. There are many ways one can go about the breathing during the pushing stage, but the advice was that you want to push when having a contraction (more force) and that at that point you generally tuck your chin to your chest to help exert more downward pressure. If the contractions are going for 60 seconds, you want to take 2 deep breaths right before it starts and then breathe out while pushing, take a smaller breath in (you don’t want to take a deep breathe in because the baby is kind of yo-yoing inside of you and you want to make sure you are pushing it down faster during the contractions), and then breathe out while you squeeze out. After the contraction, relax. If the doctor tells you not to push during a contraction, bring your chin up high and try to resist the urge. A reason a doctor might tell you not to push is to adjust the cord around your baby.

The doctor will give you updates about the baby’s location relative to your pelvis. If they are lined up with the ischial tuberosities, they are at ground 0 and you will see the head soon. If they are not there yet and are still higher up, you’ll get a positive number (of centimeters), and if their head is already visible, you will get a negative number and will probably be seeing that baby very soon.

Then we have to talk about episiotomies. So at my hospital the rate is very low (under 2%), and they will only do it if they think the vaginal tissue is going to rip towards the urethra, in which case they will cut the perineum down a little bit (in the direction towards the rectum). If it doesn’t seem like the vaginal tissue is going to rip in that upward direction (which is determined if the tissue turns white, indicating it has stretched to its max and there is no more blood flowing through it), then instead they will apply a warm compress to the rectal area to help try to warm those muscles and tissues up to get them to relax and stretch a bit more. If they do need to cut you, they will give you a local anesthesia and then do a quick incision.

Also another thing to keep in mind if you are going to a hospital is what are the state laws. In my state, it is mandatory that the baby get antibiotic drops in their eyes, and I think the TB shot before they leave. They also will prick the baby’s foot to take blood for genetic screenings. It’s important to understand what procedures are required like that, so that way you don’t find yourself fighting a state law after you’ve given birth. Also, my hospital will put antibiotics in our IV’s during labor if the mom was positive for group strep B culture during a vaginal/rectal swap between week 35-37. Other than that, if a mom comes in dehydrated, she will also automatically be given an IV for her labor.

A big emphasis that the educator couldn’t say enough was that when you have your new baby, you really want to do skin-to-skin contact. It helps warm the baby up but also is an amazing bonding experience and helps calm both the mom and the baby down. Obviously this can be challenging as a mom with eczema. I found personally that I could hold my baby skin to skin right after the birth (but also note I had been on antibiotics during the birth), and then later when home would struggle with skin to skin, where as soon as my baby was asleep and I’d put her down for a nap, I’d need to scratch like crazy.

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