Tuesday, May 29, 2012

So, You Want To Have A Natural Labor...

I am coming off my shift this morning all fired up.  It seems that so many of my patients have never been told what I'm about to tell you.  I am writing this to those who have come across this blog perhaps by doing a search on the topic.  Perhaps you are doing some research because you are expecting your first baby and you wanted to know about all your options.  Perhaps you've already done all your homework and have read through some of the thousands of articles and posts on labor and have gathered all your information about natural childbirth.  Perhaps you are an avid promoter of it.  I will tell you right now that I am NOT against natural labor.  I think it's a beautiful thing.  I am NOT going to try to talk you out of it, or make you feel foolish for wanting to try it.  But you and I are going to have a little heart to heart.

You have read all the articles that have told you how to gain control over as much as you can in the hospital.  You've read through the many samples of birth plans and have picked out your favorite points...you've even typed up one for yourself.  Good!  You've read all the research that supports the benefits of having an unmedicated childbirth including optimal breastfeeding sooner after delivery, smoother and quicker labor, emotional and physical benefits for you...just to name a few.  Good! 

But then, you've read about how to deal with contractions.  How to request that we not inquire about pain, that we not offer you medication.  You request us to refer to your contractions as "surges" or "rushes."  Don't remind you in other words.  Trick your brain.

Ladies, call it what it is. 

IT'S PAIN!

Real. Bad. Pain.

You can do all the academic preparation in the world, but unless you make peace with this fact you will NEVER be able to have the natural birth experience that you want.  There is a difference between being well-read about it and calling yourself prepared, and actually having a complete emotional and mental mindset that is deep enough to transform you during labor.  And that starts with embracing the fact that you will be in horrible, deep, mind-numbing...pain.

Do NOT come to the labor and delivery unit unprepared for this.  I've had people tell me, "People do it all the time, so it must not be that bad," or "You mean it gets worse than THIS?" (And they're only 5 centimeters.)  It drives me crazy when women come in and act surprised when it hurts.  It seems to be a huge secret in modern gibber-jabber on the Internet:  Labor HURTS.  Period.  There's no covering that up.  There is no "tricking" the mind.  Don't be fooled.

I am not telling you this to terrify you.  I'm telling you this to prepare you.  You have to come to my unit knowing full well what is ahead of you and you have to be OK with it.  Take that fact, mull it over in your head.  Put it down somewhere deep inside you and really come to a place where you know the full reality of what you are facing...and only then make the decision if unmedicated labor is the correct path for you.

You say, "Well I have a really high pain tolerance."  No you don't.

You've made a pact with your husband or partner and say, "No matter what I ask for, don't let me have the epidural."  Neither you, nor the person you are making this pact with are in pain now or have most likely never experienced any real pain so you are not in a position to be able to make this pact intelligently.

You say, "It's safest for the baby."  Come on. This argument isn't valid anymore.  The baby can have problems whether you get drugs or not.  We have the capability of protecting your baby either way.  Childbirth is dangerous.  You're not really doing much to affect safety by staying unmedicated.

OK...

So, you think you want to go for Natural Childbirth?  Good for you!  You go girl!...  Just keep it real.  Have the following points in mind:

It is a very good clue when you arrive to the unit crying and screaming...and you are only 1 or 2 cm dilated...maybe natural labor isn't the best choice for you.

Or, if you are screaming so loud that you are scaring the patients 6 doors down the hall, then maybe you should start thinking about what you are doing.  Why would you want to do that to yourself?  Really...  Unless it's some kind of attention-getting thing...but do you really want people to think that of you?  No matter what they show on TV, screaming is NOT OK with us.  (Not when you've chosen this for yourself.)  If you're screaming out of control, then maybe you are not the best candidate for natural labor.

And that's just it:  the word "candidate."  Some people are great candidates.  Some just are not.  Some are able to make peace with the pain, go into a "zone," and just do it.  Some just can't.  This is not for everyone.  Do not assume that since it's what all the most convincing articles are about, that you can just do it.  And, more importantly, don't be tempted to allow yourself to be influenced by all the voices around you telling you that if you have an epidural you are somehow less worthy, or even a failure.  They are lies.  They are NOT empowering women, they are actually limiting and oppressing women.  We are living in modern times.  Educate yourself about all your options and make an informed decision that is right for YOU.  That's empowering.

And if you've made the decision to go ahead with natural labor, then I say with all sincerity, good for you.  We will help you in every way we can.  But if there is any point in this post that I want you to remember it is this:  If you're labor begins to change from being the empowering experience you envisioned, to becoming TRAUMATIC, then stop.  Maybe you need to consider something else.  Ask your nurse or physician what options you have.  Maybe you are meant to do it a different way.

Ask for that epidural with all your heart, and don't be the least bit ashamed.

Author's note:
Yes, there are some women who are very fortunate and can labor without feeling much pain at all.  (My Mother-In-Law is one of them.) They are certainly an exception to the rule.  If you are one of these lucky ladies then congratulations!  You are blessed!





17 comments:

  1. With my second birth, I showed up at 3 am complete - as in fully effaced and dilated. I had no idea and fooled the night shift nurse. It just never hurt "that much." The delivery was a couple of painful pushes. With my 3rd the nurse/midwife delivered the baby because I progressed so fast and never made a peep because, again, it just never hurt "that much." With other labors and births I did have epidurals and some of them were great. Different births with the same woman can be so different.
    I get your point,though, and feel that the fear of labor pain can lead to either denial or a lack of self-control. When I've heard women delivering naturally and they're screaming for the 5-10 minutes of pushing, that seems bearable to those of us who have to listen to it. However,the screaming through contractions when they're not even close to delivery is a bit much. The evidence on the latest modes of epidural insertion and medication make it a marvelously safe choice for almost all women. The whole "I want it do it naturally" to earn some sort of bragging rights, and endure so much discomfort and pain is, well, silly to me. Besides, even if a woman delivers without an epidural, the lidocaine shot to be stitched up if needed is PAINFUL, far worse in my memory than the epidural insertion.

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  2. Thanks LauraT! You make a very important point. Some woman, for some very unknown reson, just don't feel pain. They are few, but nevertheless, it does happen. So, I've added a note at the bottom of this post to point that out. You are also right about added benefits of an epidural when you say that it helps with pain control for the repair after a vag delivery. I would add also that in the event of an emergency, the anesthesiologist may be able to use the epidural that is already in place instead of having to do a general anesthetic ("knock you out".) That way the mother doesn't have to be asleep for the birth. Bonus. Thanks for commenting.

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  3. I've heard people talk about the numbing effects of epidurals, but I've never experienced it. Is that a benefit only for some? It only helped with the contractions. I've had deliveries with and without epidurals, the things felt during delivery and repair were the same.

    I'm glad you're back! I bookmarked your site last year and have been checking back for posts. Thanks!

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  4. I have to give credite to anyone going through a natural birth. I don't think the word pain can really describe what it feels like to give a natural birth.

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  5. HI!! My name is Rachel and I found your blog in a search. I need to do a research paper on RNs specifically L&D RNs. I am looking to start nursing school next fall and the paper just covers the basics(why did you become a nurse, etc). If you would be interested in answering some questions for me I would really appreciate it! My email is WHATSERNAME324@yahoo.com. Thanks and I hope to hear from you!

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  6. Yes. Yes, to this whole post. Being a CNM with a 50-50 split in my patients for epidurals and unmedicated, I definitely see these issues in my practice. And I'm a realist - I tell it like it is, which sometimes pisses patients off - *shrugs*. I tell patients I can't say rushes, waves, or surges with a straight face. Sorry, just can't do it without throwing a snicker in there. That shit hurts and you just gotta suck it up and deal with it!

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  7. Hello there...I am a mother of four. My first delivery was horrible. I made my mind up with my second and third they would be delivered natural....and they were!! The pain is just as you described however I had to disagree with you about having an idea to deliver natural and not going through with it. If a woman has it made up in her mind and she is determined with a support system she can do it!!! I encourage women that they can do it. I also tell them the pain is like nothing you could ever imagine. I do...have a high tolerance for pain. This I didn't realize until after the delivery of my second baby. I had a focal point which was the clock on the wall and a scripture to help combat those contractions. My fourth child I went in and knew I wanted an epidural I just didn't want to go through another natural delivery. Anywho... I think it should be the moms choice and she should receive all the support she can get!!! BTW... The reason I'm going into nursing is because of the wonderful support I received from my L/D nurses!!!

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  8. I delivered 4 children all natural, last one in 2000, because we are rural and they didn't have epidurals. The first one was very traumatic (i had experienced 3 other births with epidurals). The next one was more bearable. The next one, i labored beautifully, but the delivery was traumatic. The last one, was as perfect as l and d can be. Its a crap shoot.

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  9. And please...when we say it hurts we mean you will think the following:
    "I must be dying, something is wrong".... nothing's wrong, that is normal.
    "I would rather be dead right now "...no you wouldn't...just get through THIS contraction.
    "I might kill someone." ...there is no hitting, kicking, biting, spitting or KILLING your nurse...everyone else is fair game.

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  10. Ha! I love this! I'm an oncology nurse, who's delivered both her babies naturally. And it SUCKED!!! But I went in with an open mind both times and just planned on doing as much as I could on my own and rolling with the punches. My second delivery was much tougher than the first (I naively thought it would be easier!). I think because it happened so much more quickly and I was starting out much more exhausted and frazzled (I had a toddler at home and was 12 days overdue at this point!). My water broke with the 2nd and I immediately had a 3-minute long, ridiculously painful contraction. I started crying and the resident in the room asked, "How about an epidural?" That made me cry harder and I almost gave in. But thank God for the tub. I immediately got into the water, regained my calm, and toughed it out from there. 4 hours and 5 pushes later, my beautiful daughter arrived! Each woman has got to do what works for them; and if anyone judges you for what you decide, screw them! To each his own...

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  11. This is perfect! It's funny-my mother in law had 5 kids "naturally" and it wasn't painful for her either! Huh! Everyone is different, but I do notice that most of your comments from others are in regards how they delivered naturally. I was in active labor for almost 24 hours, had an epidural and ended up with a c-section. By the time I received my section my epidural had worn off and that pain was nothing I ever want to experience again!

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  12. I had three vaginal deliveries. The first with IV pain med that made me nauseous, the next two, without meds or anesthesia. I have a low pain tolerance under normal circumstances but understanding what the pain of labor does and looking forward to holding that new baby in my arms, I did beautifully through natural deliveries. As a labor and delivery RN, I understand that some labors are protracted or complicated and many women are not well prepared for the natural deliveries they desire. All these women will do better with epidurals. But never doubt that the majority of women who deliver "naturally" do so with pain. They know they will feel pain and deal with it, just as some people conquer a marathon run or a mountain climb.

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  13. "You can do all the academic preparation in the world, but unless you make peace with this fact you will NEVER be able to have the natural birth experience that you want."
    YUP.

    Awaiting my first, and I am a well-rounded candidate for natural labor, so I am prepared for the PAIN. If it gets to be too much and I can't handle it anymore, I'm asking for help. It's not a damn badge of honor to have given natural birth; it's a choice like all the other ones you'll make with your kids. As long as baby and mom are separated and all are OK, who cares?!

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  14. Actual research shows that there is a continuum of pain, from those who are born without the ability to experience it, to those who can hardly exist in the world because of it. The best study had 100 random patients with heated discs placed on the arm. The PET scans of these people revealed a wide variation in pain receptors activated. The research subjects had no ability to control this response.
    What this says is that your pain is your pain and you are not a Birth Goddess if you don't have labor pain -you are just lucky.
    Ann

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  15. I am really working hard to go natural (my mom's epidural messed up her back permanently, so I'm a bit scared of them, despite the fact that they're the safest pain relief for pregnant women).

    My doula cautioned me about this very issue when we started working together. She's had clients who expected painlessness and had bad birth experiences because of it. She wants to prepare me to handle pain, because she doesn't want me banking on being genetically lucky.

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  16. Thank you, thank you for this article. Expecting my first. Want to go natural. I found your blog because I googled "do nurses hate natural births". This was exactly what I needed to hear. And I promise I wont scream :)

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