Okay, I give up -- Birthing position help, please?

Help (again) please:

At the risk of just getting a string of replies from Todd, and
admitting that I did NOT understand Larry's post about the rhombus of
Michaelis very well (I guess that means I indeed have a problem
understanding English, according to the post), what birthing position
should I vie for?

My hospital is a bit, umm... old-fashioned. Semi-sitting is about
the best they do there, although if I actually get my doctor for the
birth and not the resident on call (I am afraid my doc won't be
there), I have a *bit* more flexibility with what I can try, but not
much. There are no squat bars, birthing pools/tubs, and the nurse at
my preregistration said she'd never heard of anyone doing anything
other than semi-sitting there (this is the hospital, though, with a
30% Caesarian rate, and the nurse also admitted she "couldn't remember
the last time someone didn't want any drugs" when I made the request),
so my options are limited. However, I want to explore every
possibility anyway. Any ideas?

I'm sorry I keep posting questions these days -- as my due date
approaches, I have more and more questions going through my head, and
as I'm still only seeing my doctor every three to four weeks, I can't
stand to wait until the next time I see him. Thanks!

-Carlye
Baby girl "Afton" due 9-25-04

Carlye wrote:

Help (again) please:

At the risk of just getting a string of replies from Todd, and
admitting that I did NOT understand Larry's post about the rhombus of
Michaelis very well (I guess that means I indeed have a problem
understanding English, according to the post), what birthing position
should I vie for?

My hospital is a bit, umm... old-fashioned. Semi-sitting is about
the best they do there, although if I actually get my doctor for the
birth and not the resident on call (I am afraid my doc won't be
there), I have a *bit* more flexibility with what I can try, but not
much. There are no squat bars, birthing pools/tubs, and the nurse at
my preregistration said she'd never heard of anyone doing anything
other than semi-sitting there (this is the hospital, though, with a
30% Caesarian rate, and the nurse also admitted she "couldn't remember
the last time someone didn't want any drugs" when I made the request),
so my options are limited. However, I want to explore every
possibility anyway. Any ideas?

You must first of all change your thinking.
Your options are not limited at all. What are they
going to do? Tie you up and give you drugs and
strap you down to the table so you can't move? They
can't force you. What they *can* do is make you
uncomfortable with your choices and lead you down
a path that makes your choices increasingly impossible.
Basically, to put a fine point on it, they can bully
you into their way of thinking. Whether they will
succeed or not depends on how assertive you are willing
and able to be and whether you have people to support
you (DH, doula, others) who can help you be assertive
and get what you want.
Semi-sitting isn't going to help you get
the optimal amount of room for your baby to be born.
You might luck out and not need that much room, but
if you need it, semi-sitting isn't going to help.
You don't need any fancy equipment to get a better
birthing position, though. You can roll onto your
side. You can flip over onto all fours. Your partner
and someone else can help support you standing or
in a squat. For myself, I chose side lying for my
first and hands and knees for my second and third.
Side lying you can probably manage with help if you
have an epidural, but the others will probably require
that you have more mobility than an epidural will allow.
With side lying, it helps to have someone to hold your
upper leg. If you're on all fours, it helps to have
some pillows under your chest or to lean over something
so you're not bearing all your weight.
So, step one is to do what it takes to avoid
pain meds. In a first labor, your biggest enemies are
fatigue and dehydration and immobility. You can most
effectively combat them by staying home absolutely as
long as possible (in an ideal world, you'd hire a
doula or midwife who will come to your home and help
you labor there and determine when you really need to
get to the hospital so that you get there in the nick
of time). You need to drink (very important) and eat
(light, easily digested foods) so that you don't
cave just because you're too exhausted from starvation
and dehydration to manage a longer labor. You should
rest/sleep through as much of early labor as you can,
but other than that, stay out of bed as much as you
can. You don't have be out there hiking, but get
upright and allow yourself to move around to deal
with the pain. Make sure you pee every hour, because
if you go to long without, you can get to the point
that you *can't* pee on your own, and then you'll
need to be catheterized or a distended bladder can
impede the progress of your labor. Refusing an
IV will certainly help make mobility easier. If
you get too much grief on that, compromise and allow
a hep lock for emergency access but don't allow
them to hook it up to anything.
Step two is to simply refuse to climb in bed
and stay there, even at the hospital. Refuse
continuous electronic monitoring. They may require
at least *some* monitoring (and they should do some
monitoring), but if you refuse to allow them to strap
the monitors on, you won't get stuck. Make them
hold the monitor on you to get whatever they need
(or use a fetoscope or handheld Doppler). Most women
I know who go unmedicated *HATE* lying on their backs
in bed. It seems to be almost universally one of the
most painful positions in which to labor (I'm sure
there are exceptions, of course).
When it comes time to push, just flat out
refuse to get on your butt. Your support people
need to help you be assertive and need to help you
by making suggestions and helping you into other
positions. Also refuse coached pushing and push
when and how you feel like it. In this, it would
be very helpful to have a doula on hand to help
guide you towards effective measures and away from
ineffective measures while still allowing you to
listen to your body. For instance, you shouldn't
be counting to ten and holding your breath and
pushing with all your might on command; however,
in the heat of the moment it can be helpful to
have someone encourage you to relax, to make low
noises rather than high-pitched noises, etc. You and
your support people will have to be willing to ****
off the doctors and nurses, since it sounds like
they're not likely to be cooperative. They're not
going to tie you down. They're just likely to apply
a lot of pressure. It's your right to resist that
pressure if you like, though it's easier said than
done.

Best wishes,
Ericka

My doc was very supportive of trying different things to get Kay moving.
We tried me on all fours, occasionally sinking to the "childs pose" from
yoga, they also would have tried anything on my side, and they gave me the
end of a towel to pull from to help concentrate on my abs when I was on my
back (kind of a "form" thing for crunches, I guess). Another option might
be letting your coach/partner sit on the bed and you put your arms
over/outside his/her forearms and legs, so they are supporting most of
your weight and you are mostly upright, with a bit of distance between
your end and the floor so the doc should be able to have some room to
manoever.

On 18 Aug 2004, Carlye wrote:
I'm sorry I keep posting questions these days -- as my due date
approaches, I have more and more questions going through my head, and
as I'm still only seeing my doctor every three to four weeks, I can't
stand to wait until the next time I see him. Thanks!

Are you kidding? By this point in my pregnancy I was a loon.

Get all the information you can, but be prepared to just let it happen,
too.

On Wed, 18 Aug 2004, Ericka Kammerer wrote:

You must first of all change your thinking.
Your options are not limited at all. What are they
going to do? Tie you up and give you drugs and
strap you down to the table so you can't move? They
can't force you.


However, even with a cooperative doc and staff, there are some
circumstances that are going to be beyond our control. My doc and doula
were all for natural, no drugs, etc., but when my contractions stopped
after my water (with meconium) broke, they waited a few hours and then
started with pitocin and with that, monitoring. I imagine different
facilities have different guidelines and recommendations, but my hospital
requires constant monitoring with pitocin, so rather than being harnessed
in the bed with an external monitor, I chose the internal monitor so I'd
have the option of getting up and walking around, which I took advantage
of for about 15 minutes before the contractions just knocked me on my
butt. But at least I didn't get a catheter until after the birth.

My suggestion is to make sure your support and medical staff know where
your boundaries a No painkillers? Minimal invasiveness? And then know
what *their* boundaries a Pitocin requires monitoring. If your water
breaks, you get a seven hour window before they start up pitocin to get
things moving. If you cannot deal with their boundaries, get a different
facility, but other than that just be prepared for a flux of what's going
on.

Carlye writes:
: Help (again) please:

: At the risk of just getting a string of replies from Todd, and
: admitting that I did NOT understand Larry's post about the rhombus of
: Michaelis very well (I guess that means I indeed have a problem
: understanding English, according to the post), what birthing position
: should I vie for?

: My hospital is a bit, umm... old-fashioned. Semi-sitting is about
: the best they do there, although if I actually get my doctor for the
: birth and not the resident on call (I am afraid my doc won't be
: there), I have a *bit* more flexibility with what I can try, but not
: much. There are no squat bars, birthing pools/tubs, and the nurse at
: my preregistration said she'd never heard of anyone doing anything
: other than semi-sitting there (this is the hospital, though, with a
: 30% Caesarian rate, and the nurse also admitted she "couldn't remember
: the last time someone didn't want any drugs" when I made the request),
: so my options are limited. However, I want to explore every
: possibility anyway. Any ideas?

: I'm sorry I keep posting questions these days -- as my due date
: approaches, I have more and more questions going through my head, and
: as I'm still only seeing my doctor every three to four weeks, I can't
: stand to wait until the next time I see him. Thanks!

: -Carlye
: Baby girl "Afton" due 9-25-04

Carlye,

Ericka's advice is excellent. To put the important points in bullet
format...

1. Do not go to hospital until absolutely the last minute. Every
extra minute in the hospital is an opportunity for unwanted
interventions.

2. Eat and drink in early labor. If you can't eat anything heavy
try jello or yougert. Drink apple juice. Stay hydrated and get
some nourishment.

3. Read Henci Goer's "Thinking Woman's Guild to a Better Birth."
When you finish, reread it. Hurry!

4. Hire a Doula and make it *VERY CLEAR* to her exactly what you expect.

5. Refuse CFM, do NOT allow the monitor to be hooked up. Tell them it's
fetoscope, handheld doppler or nothing at all. Refuse to lie down
in the bed. Refuse the IV. Personally, I would refuse even the
heplock.

6. As Ericka says, change you way of thinking. You MUST have the notion
that you CAN and WILL refuse anything you think is unwarranted. You
MUST NOT think that you HAVE to do what they tell you.

Good luck,
Larry

On 18 Aug 2004, Larry McMahan wrote:
Ericka's advice is excellent. To put the important points in bullet
format...

In general, for most births, I wholeheartedly agree with Ericka, but there
is a line between "the ideal birth situation" versus "medically necessary
treatment because something is actually not going right." Wasn't there a
woman who was being prosecuted for refusing a c-section for twins and
having one stillborn a few months ago? Isn't this where becoming an
informed patient comes in handy? There's a difference between
intervention for the convenience of the staff -- and I wouldn't be
surprised if my pitocin dosage was adjusted throughout the day to better
time the birth for my doc -- versus the fact that I wasn't having
contractions for 7 to 9 hours after my waters broke and there was a danger
of infection (and, in fact, my bloodwork showed there was an infection
going on *somewhere* but none of the tests taken later were conclusive
about where.)

6. As Ericka says, change you way of thinking. You MUST have the notion
that you CAN and WILL refuse anything you think is unwarranted. You
MUST NOT think that you HAVE to do what they tell you.

The crucial word to me here is "unwarranted." Having a catheter put in
because the nurses don't want to help you to the bathroom is unwarranted;
having a catheter inserted because you didn't go to the bathroom for four
hours of labor and now the bladder is blocking part of the baby's exit is
probably a very good idea.

T Flynn writes:

: However, even with a cooperative doc and staff, there are some
: circumstances that are going to be beyond our control. My doc and doula
: were all for natural, no drugs, etc., but when my contractions stopped
: after my water (with meconium) broke, they waited a few hours and then
: started with pitocin and with that, monitoring.

There is a vast diffrence between using interventions because something
outside your control has happened that compromises the birth and
inappropriately administering interventions in a perfectly normal birth.
There are still more birth today that inappropriately receive these
interventions when they don't need to than those that receive them
appropriately when they HAVE to.

Larry

On Wed, 18 Aug 2004, Ericka Kammerer wrote:
T Flynn wrote:
However, even with a cooperative doc and staff, there are some
circumstances that are going to be beyond our control. My doc and doula
were all for natural, no drugs, etc., but when my contractions stopped
after my water (with meconium) broke, they waited a few hours and then
started with pitocin and with that, monitoring.
Absolutely--if real issues crop up, that's one thing.
I meant in the absence of real complications. Sorry I wasn't
more specific.

But I think it's a matter of finding out what the doc and hospital
consider to be "real complications" -- is it a real complication if your
labor is going to bring you to birth right around their tee (or tea!)
time?

"Carlye" wrote in message
om...
Help (again) please:

At the risk of just getting a string of replies from Todd, and
admitting that I did NOT understand Larry's post about the rhombus of
Michaelis very well (I guess that means I indeed have a problem
understanding English, according to the post), what birthing position
should I vie for?

My hospital is a bit, umm... old-fashioned. Semi-sitting is about
the best they do there, although if I actually get my doctor for the
birth and not the resident on call (I am afraid my doc won't be
there), I have a *bit* more flexibility with what I can try, but not
much. There are no squat bars, birthing pools/tubs, and the nurse at
my preregistration said she'd never heard of anyone doing anything
other than semi-sitting there (this is the hospital, though, with a
30% Caesarian rate, and the nurse also admitted she "couldn't remember
the last time someone didn't want any drugs" when I made the request),
so my options are limited. However, I want to explore every
possibility anyway. Any ideas?

I'm sorry I keep posting questions these days -- as my due date
approaches, I have more and more questions going through my head, and
as I'm still only seeing my doctor every three to four weeks, I can't
stand to wait until the next time I see him. Thanks!

-Carlye
Baby girl "Afton" due 9-25-04

I found having the bed inclined, being on the bed with my back to the room
and using the bed to help me squat VERY helpful. I would go into all fours
in between contractions to "rest". I would kind of climb up the bed when
the contractions came on. Hope that describes it well enough. Also see if
the hospital has birth balls or if you could bring one (you can just get one
at walmart or similar store, they are just exercise balls), it was key to my
labor! You could go ahead and get one and start using it already. It
really helps with relaxing the pertinent muscles and your hips. It also
helps getting you into a rythm with rocking and stuff. You can also use it
to prop yourself on with your knees on the floor and rock. Anyway, Good
luck!!
Kat
mama to maggie 11/03/01
and will 02/10/04

T Flynn writes:

: In general, for most births, I wholeheartedly agree with Ericka,

Yes. And I responded to your response to her. :-)

: but there
: is a line between "the ideal birth situation" versus "medically necessary
: treatment because something is actually not going right."

And I agree wholeheartedly with you here. :-) Well, almost... I would
call the first the "normal birth situation" instead of "ideal" , because
that is exactly what it is. And until something happens that changes a
normal birth situation into a situation requiring medical intervention,
it should be treated normally, and not exceptionally. That was exactly
what Ericka's post and my post were all about. It was NOT about refusing
medically necessary treatment.

: Wasn't there a
: woman who was being prosecuted for refusing a c-section for twins and
: having one stillborn a few months ago? Isn't this where becoming an
: informed patient comes in handy?

Aside from agreeing wholeheartly with your last sentence again, I wonder
what connection this possibly has to what we were talking about.

: There's a difference between
: intervention for the convenience of the staff -- and I wouldn't be
: surprised if my pitocin dosage was adjusted throughout the day to better
: time the birth for my doc -- versus the fact that I wasn't having
: contractions for 7 to 9 hours after my waters broke and there was a danger
: of infection (and, in fact, my bloodwork showed there was an infection
: going on *somewhere* but none of the tests taken later were conclusive
: about where.)

Hmmm. Again, I think you are looking at this whole discussion through
the eyes of someone who received medically necessary interventions.
Again I am in violent agreement that there is a difference between
interventions for the convenience of the staff, and medically necessary
interventions. However, intervention for the convenience of the staff is
quite common, and the OP has presented ample evidence about her hospital
that they practice it as their normal routine. Both Ericka's and my
advice were directed at how to minimize the distuptive effects of that
routine.

: 6. As Ericka says, change you way of thinking. You MUST have the notion
: that you CAN and WILL refuse anything you think is unwarranted. You
: MUST NOT think that you HAVE to do what they tell you.

: The crucial word to me here is "unwarranted." Having a catheter put in
: because the nurses don't want to help you to the bathroom is unwarranted;
: having a catheter inserted because you didn't go to the bathroom for four
: hours of labor and now the bladder is blocking part of the baby's exit is
: probably a very good idea.

Again, violent agreement. That was the point. Avoiding unwarranted
interventions. Don't get your knickers in a knot. :-)

Larry