Monday, February 25, 2013

Owning Pain

I had a conversation about epidurals with an OB friend of mine this weekend.  His thoughts were, "Sometimes I don't know if I should offer one or not."  I absolutely understand this conundrum of the primary caretaker in a hospital birth.  Firstly, it's assumed most people are going to want one at some point.  In hospital births in which people don't have a lot of support, it's rare to see those who intend unmedicated birth actually have one, especially for those women whose births end up being quite long.  So offering is reassuring and welcomed by the vast majority of women who birth in hospitals.

On the other hand, and I always really appreciate hospital staff members for this, many of them upon hearing a mother's plans for an epidural free birth don't wish to mention the epidural because they don't want to come off as interfering, or being one of "those" medical people who like to sell epidurals hard because they can't stand the idea of someone being in potentially a lot of pain.

My thoughts on the matter, and many natural birth advocates may disagree, are that it is absolutely fair for a medical person, upon arrival of a mother at a hospital in labour,  to explain that there IS pain relief in the form of a, b, c, d, and epidural.  Adding a, "I just want you to know in case you choose this, but that's all we'll say on it." would be great too.  Many are aghast when any mention of an epidural is made at all.  As doulas, it can be really frustrating to hear these words.  We jump to the thought that our vulnerable, paining client will hear this sweet phrase, then jump on the epidural bandwagon, only to feel disappointed in herself later.  But in a way, isn't this assuming that a mother will translate the epidural offer as a disempowering question?  Because you know, it isn't necessarily so. I've been asked if I wanted an epidural in my own hospital birth.  It did not make me want to have an epidural, even though I had been in labour for a couple of days.  When I decided to possibly consider epidural, it had nothing to do with peer pressure.  It came from my own core.  I gave birth before I decided, so I never did end up getting one, but had I chosen it, it would have come from a very informed and empowered place. I have seen many women asked if they want one, and those really into the process of normal, natural birth just don't seem to take it too seriously.

On of the reasons I think it is fair to provide a mother with the information that there are epidurals available in the hospital for her use if she wishes is because the caregiver's challenge  in a busy hospital is that they may not have the time it takes to really get to know the patient's wishes and the thoughts about those wishes the family/or friends present may harbour.  What pushes me over the line into the belief that an initial little epidural shpiel is not a terrible thing is that on occasion, the mother might be under the immense pressure of partner/family member/friend/even doula to NOT have an epidural at any cost.  I have been in many births where Grandma or Mother-in-Law or Husband or Girlfriend Who had her Own Natural Births were quite hostile about the idea of epidurals, and willing to project that hostility onto the caregivers just for doing their due diligence in mentioning the hospital's availability of pain relief.  Okay, true, usually it is the opposite...usually Moms want natural and the argument is FOR her to take the epidural (don't be a hero, yada yada).  But sometimes we have the mom who is not sure, or the mom who runs into real suffering and everyone else on the birthing team had a hard time surrendering to her desire for epidural.

To KNOW that someone in the hospital is on your side and supportive of your choice to eliminate pain is not a bad thing.  Yes, it IS a bad thing to have an epidural shoved down your throat every time you yell with a contraction.  That is not empowering.  But I don't think mentioning they exist before labour gets super charged is terrible at all.  There are women who come into the hospital with no prior prenatal care, perhaps new to the country, culture, and language, perhaps who have birthed previously in horrendous conditions.  I had one client who had birthed in another country and was absolutely traumatized by the cruelty she was subjected to.  She was in a room full of other birthing moms, the nurses kept telling her to shut up, that she couldn't move or make a sound, nor have anyone else there to support her.  Her thought was, "Well, I did it naturally last time, I can do it again this time."  As a doula, I talked to her about common hospital procedures, we talked about the epidural, and as always, outlined as best I could the risks and the benefits.  It didn't occur to her to think about epidural, due to her previous natural birth.  But when she went into labour, she was triggered into a post traumatic episode related to her prior birth years back.  When we got to the hospital it was casually  mentioned she could have an epidural if she wanted by the super friendly, supportive nurse.  My client looked surprised, regardless of what we had gone over prenatally.  As pain increased, her stress increased, no matter what I did.  She said to me, "Is it true I can just get pain relief if I want it?"  I said, "Absolutely.  You're doing great and your labour is progressing beautifully, by the way.  Would you like to try the shower?"   She said, "No, I want the epidural.  I remember what you told me about them.  I feel like I really need one."  And that was that.  When she got it, I saw a look of absolute peace.  She had space to process a lot of things from her last birth, and she found incredible healing in the ability to choose pain relief when in her past birth it wasn't an option.  I was glad for her.  She had a beautiful birth.  To know that a medical person supports the desire to help them out with pain can be a godsend to some.  It isn't for us to judge.

Now having said that, once the offer is out, it shouldn't be repeated a million times. Or rarely at all. THEN Mother's strength becomes compromised as she is repeatedly taken out of her reptilian brain, from which she may wail, cry and moan to help her through contractions, into questioning herself.."am i not doing well?  Am I bothering people?  Is something wrong?  Why do they tell me I need drugs?"  This comes from people outside her experience trying to own her personal process of birth in the guise of "saving".  Their thoughts might be, "She's not relaxing.  She's getting too tired.  I can't stand hearing those vocal expressions.  They make me uncomfortable and I need to DO something to get this woman to stop being a masochist.  Maybe someone is putting her up to this!"  But women in labour are generally pretty fierce, and even the shy ladies will start demanding an epidural if that's what they really want, so staff members generally don't need to press the epidural point. Women whose family members are against it will often simply refer back to the doctor's initial words and say, "They said I could take one." and feel more strength in their conviction to request it. Even if nobody offered a suffering lady drugs, if they are decided in using one, they will usually continue to ask for them. Of course, we do the doula if we know our clients desired an unmedicated birth and many women change their minds as they find their ways to cope, but you do come to a point where to try to sway a woman from what she clearly has gone hellbent on becomes an act of disrespect.  There is a line between supporting her original intentions to forcing her to own pain she truly doesn't want anymore.  I can't say I've had anyone say, "well, I ended up taking one because the staff mentioned epidural once when I arrived and it broke my resolve."   They took it because they wanted it.  No blame, no shame.  Or perhaps the continued, "are you SURE you don't want a nice, juicy epidural so you can sleep and have no more pain" song eroded their confidence after a while.  Those who take epidurals on their own steam usually don't regret them much.  Those who feel coerced often do.

I like using the analogy of running a marathon to illustrate to medical people not sure of when to intervene on the pain relief front.  How challenging it might be to a marathoner to instead of having the road full of people yelling, "You can DO's water, high fives, gel go, keep running, don't give up!" say, "Don't be a hero!  You have nothing to prove!  We'll put you in the wheelchair and you'll still get you to the finish line one way or another, it doesn't matter that you stop running!  The process doesn't mean anything. We can't stand to see your pain anymore."  And it IS pain.  My dear friend and colleague Sesch is a marathon runner and she tells stories of people yelling with pain, limping along during their runs.  She says she has seen women bleeding down their legs as their menstrual protection fails after hours running, people shitting themselves, and vomiting down the front of their shirts...but not stopping.  And what do we do for these pained runners when they pass we onlookers by?  We screech and cheer with pride and total encouragement.  The funny thing, is that thousands upon thousands of people are willing to put themselves through this marathon torture.  Seriously, spaces to run get sold out quickly, as they can only have a limited number of folks running giving the resources it takes to support an event like that.  So if we don't think about jumping in and saving the crazy marathon runner limping her way to the finish line, why are some so loathe to let the labouring woman just be and do her thing to get her finish line?  Yeah, it may involve some yelling, vomit, and poo, but the high at the end, (which is why most runners embark upon the marathon journey), is just so friggin' good for most.  You OWNED that body process, and rocked it how you wanted.  You are gloriously, and endlessly badass.  And birth for the most part is WAY healthier than a marathon run.

At the beginning of the marathon, people are made aware by the sponsors of where the stations are where they can stop for medical attention, what part of the road to go on if they need to walk, etc.  Then the gun goes off and the journey is up to them and what their bodies and minds allow them to do that day.  And they are cheered on and supported, through howling, limping dehydration and loss of control of bodily functions.  When they simply cannot run, walk, or crawl anymore, they stop and cry "Uncle".  It's all good. Those who can't stomach watching the show leave the event.  Sounds like this would be a reasonable recipe for birthing too.

Friday, February 1, 2013

The Pride of Birthing Accomplishments

For anyone who has ever doubted the importance of the impact of a woman's birth experiences upon her life, I thought I might share this.

As many readers know, I've been dealing with some major health issues.  Statistics of my chances of survival get bandied around while I stick my fingers in my ears and go, "lalalalalalalala".  I am not interested in these stats at all.  I focus on what gives me passion and what feeds my sense of power. That's all I need to really know.

I was sitting in the bath today, thinking (as I often get my best thoughts in the bath) of what have been some of the most powerful experiences of my life. I can unhesitatingly say the most powerful have been my birth experiences.  I am one of those women incredibly blessed to be able to look back upon four births with a sense of deep, glowing, beautiful accomplishment.  What people perceive as powerful is individual.  It isn't about some standard to judge one's birth against, it is ultimately about how one feels about her birth.

I have 2 oncologists I alternate in seeing for checkups.  One is brilliant with his patients. I've already talked about him, so I won't go further with that.  The other is the one who diagnosed my cervical cancer.  Sweet guy for sure, but because I haven't really dealt with him post treatment, I'm a bit nervous about how he's going to treat me.  He is decent and kind, that's already been established.  But I fear he might be the type to give me big "reality checks" if I come off as "cocky" for fear I may feel like a "failure" if I do end up croaking.     So much in Medicine seems to be geared to making sure a patient doesn't get their hopes up too high so their hearts don't get broken, but why the heck not?  That is literally encouraging half living until you die.  I mean, you don't have to REMIND me of how serious my illness was, so let's just agree to unbridled hope, which I believe influences and nourishes our biology for the better.

The point being, having a strong well of Resource within me, fed by my feelings about my glorious births, gives me immense power.  I can connect to and draw from that power whenever I may feel shitty about myself, hanging my head like Eyore the Donkey sighing, "Woe is  me....I had body is a lemon."  My passionate belief about the empowering qualities of a well perceived birth are so strong, they led me, like others, to pursue work that could potentially help others have great feeling births too.  It beats the depression, trauma, guilt, shame, feeling of loss, etc. that so many women associate with their births.  Had my births been different, I may not have the sense of as much power as I do, and I could be in a very different place in my healing process right now.  Birth doesn't just touch the day our babies come into this world, which is why it drives me bonkers when people claim childbirth is only a means to an end;  it emphatically touches us for all our lives.  A bad experience can certainly be healed and integrated, but I'm glad I didn't have to expend energy in that department, that the glory is right there and ready, easily accessed in that well of Resource.  I think of Lance Armstrong (let's put aside his troubles for now), and how advanced his testicular cancer was.  It had metastasized to his lungs and other areas.  Statistically, most don't survive that widespread of cancer, but what an amazing resource of power he must have to dip into knowing the accomplishments of his spectacular body (blood doping or not)!  Feeling badass undoubtedly has long term curative properties.

I sometimes have fantasies of the gynecology oncologists giving me grave news or breaking down statistics for me.  I figure as gynecologists, most of them have some pretty thorough OB training, and have seen many births.  I see myself asking, "What would be your thoughts about a first time mother,  a five foot not quite one inch tall 98 pound woman (when not pregnant) having a completely OP baby, the baby's head visible for three hours of the second stage?"  "Oh, impossible, never gonna come, she'd need a Csection or at least an episiotomy and/or instrumental delivery".  WRONGO!  I pushed that kid out stargazing while epidural, no tear.  "Hey, how about a second time mother birthing a substantially smaller, earlier baby than her first, but in labour for a couple of days, stuck at five cm for about 12 hours, then 9cm for a few hours?"  "Oh, that's a terrible situation, not normal at all, definitely something wrong, C-section for sure, or at least an epidural for rest."  NOPE.  Pushed that baby on out stargazing too.  No epidural.  No tear.  "Ever seen a woman have a labour of a term baby in 40 minutes from the first contraction to the baby, born with water bag and perineum intact?  NO?  Gee, this is all one one woman's obstetric history, Docs!  I have nothing to say remarkable about the fourth, it was fast, easy , and normal.  Except, oh yeah, I caught him myself while I was on my hands and knees.  Yeah, just reached between my legs and received him on my own. That's not at all unusual in my world."

I feel the power surge at the thought of this interaction, not because I have any desire to argue the rightness or not of clinical choices with a gynecologist or feel good about shunning the beliefs of a medical doctor, but because my birth stories, each one a shining picture of beautiful uniqueness, as all births are, fill me with a sense of badass that nobody can ever take away from me.  When I've talked to doctors about my births they don't criticize me, they actually say something like, "Oh, wow, that's pretty amazing, I don't see that often at all.  Good for you!"  The point is, I, as many women do when they are able to choose to birth on their terms, defied statistics.  I stretched the boundaries of what is medically considered to be normal birth, picked my battles with courage (yes, at my and my baby's own risk...that is for me to decide), and I feel, though some of those births were intensely challenging, success unparalleled.  And this is GOOD for me.

I don't want to yell at the doctors, "In your faces!" I simply want them to know how superimposing their stats onto me limits my potential as a fully recovered and healed human being, my births being evident of how wide I can stretch, of how very much I can handle.  And, by the way, had these births ended in necessary Cesareans or episiotomies or forceps, I don't think they would have too much altered my sense of success at how far I went (I would have gone a lot farther had I needed to).  I chose my own battles, so I would not have felt a "failure".  I would have gone into an OR in a blaze of glory and emerged victorious.  And may that be, hopefully when I'm a bout 193 or so, how I will face my own death.

Call it feminine macho-ism if you want, but if at this point in my life, dealing with what I'm going through, I have the ability to look back to those births that I DID and glean power that is healing, uplifting, and inspiring, then guilty as charged for laughing, swinging my vagina around like a lasso, shouting, "Yippie kay-yay, Motherf****ers!"