Client terrified of birth - Page 3

[lorijds]

Victorian, visualizing Aragorn/Viggo could get me through a hell of alot of pain, too.

[doulajen]

Originally Posted by doctorjen

I don't mean to keep repeating myself but I really practice in the middle of nowhere. I'm feeling more hopeful that I might be able to track down a doula, but there aren't any acupuncturists for miles! I know a lot of these suggestions are wonderful, but they are hard to promote around here. I live in an area where complementary health practices are not well known or respected. I can't even get women to try a chiropracter to turn a breech baby (and there is a Webster certified chiro an hour away) let alone consider anything more alternative. One mama with a breech baby told me she'd much rather have a cesarean than try anything crazy like a chiropracter!

We need doctors like you up here in Milwaukee! Have you thought about relocating???? I am sure that I could have a ton of new clients linning up at your door!!! What town do you live in? I know some doulas in IL and would be happy to see if one of them is willing to travel or knows someone closer. Jen

[NoraB]

Yeah, if you relocated to my area, I'd be knocking on your office door the same day. LOL

[HerthElde]

I agree with other posters that the best thing would be to try and get her to specifically address her fears - first, of course, she needs to identify exactly what she is afraid of.
Is it the contractions? If she aware that if she lets go of her fears of pain her labour will likely progress more quickly? Does she realize that fear can actually release hormones which can stop or considerably slow labour? If she does realize that, does that add to her overall anxiety? Is she able to access her primal self and exist solely on instinct for a while? I know it sounds a little far fetched if her attitude is very societally influence, but different approaches click with different people (some need logically based information, others instinct based, others faith based). I found that while I could have used the word "pain" to describe my contractions, "intensity" was really a much more accurate description - like an orgasm I wanted to just stop already.
Is she scared of the actual pushing part? That the baby won't fit? That she'll tear? It may help to remind her just how stretchy a vagina is, even for sex. A woman might have trouble getting a small tampon in, and a day later have wonderful painless sex with a man whose circumfrence is the same as a pop can. If she realizes that women's bodies are capable of such feats, that might help her.
Personally, because I've had damage to my cervix which resulted in painful sex for a long time, my fear was that my cervix would hurt while it was dilating. It took me a long time to realize that was what I was afraid of, but once I did, I was able to deal with it. I opted to use EPO capsules vaginally to soften it, and whether they actually physically helped or not, they certainly put my mind at ease.
It's very possible that her fears have less to do with labour and more to do with having a baby she hadn't planned for. She may well just be focusing on the "pain" of labour in order to avoid thinking about life with a child she had never planned on having.
I'd recommend a homeopath. Even a phone or email consultation.

[doctorjen]

Thought all of you who had such good ideas might like an update.
My client birthed her baby boy yesterday. Her water broke at home, at 7 in the morning, before contractions at 37 1/2 weeks (really not my first choice for how labor would start for a terrified first time mom.) She came straight to the hospital. Around noon, she started contracting. By 2 o'clock, although she was still seeming to breathe well with contractions which weren't regular yet, and was rocking away in a rocking chair, she was asking for pain medicine. We ran into a little snag there, as she was absolutely unable to tolerate anybody examining her cervix (even me, moving exceptionally slow, talking her through it, etc.) Technically, we are supposed to chart in the record someone's cervical exam prior to giving any pain meds. We decided to make an exception, though, and she had some IV stadol which pretty much made her sleep for 2 hours. When she woke up, and asked for more pain medicine, we decided to go ahead and start an epidural. After her epidural was working well, and she had a little rest, the nurse was able to check her cervix and she was 9 cms! Shortly after that, she had some urge to push, an the baby was very, very low. It took her quite a while to get the hang of pushing. Unfortunately, she was one of those women for whom the epidural doesn't work well on the perineum and the sensation of pushing and the baby moving down was really stressful for her. She did finally push her little boy out, and 6:47 pm. She did have a pretty involved 2nd degree tear - probably from pushing mostly on her back as we couldn't get her to stay in any other position. 7 lbs 15 oz little blond fellow (not bad for a 37 weeker!) who's just adorable.
Today, she seems to feel pretty good about her birth, and was surprised it was so short. She has said several times that she's not doing it again, though!
So overall, not what I would have chosen, but it worked out okay for her.

[pamamidwife]

I'm so glad that it went relatively well. She was lucky to have you as her provider, rather than someone that would have forced her to have repeated traumatic vaginal exams.

[Mamajamz]

after the fact, but anyway...

I just found this thread, and am so glad to know your client had her baby! Wonderful news. I'll say this in retrospect, and with possible implications for integration of her experience...
One thing that really jumped out at me in reading the posts is the issue of some women not being able to own their bodies, seeing it as "bad", out of their control, etc. I wouldn't be surprised if there is something there that she hasn't been ready to face quite yet, as if she is afraid to *know* her own body and the power that it has and what it is able to do. I have seen that with many women who have experienced sexual abuse and have felt that the body experienced something too bad to be integrated into the psyche and therefore cannot be trusted in any way. The fear of pain is also a deep deep fear of plain ol' feeling anything. No sensation can be trusted, especially those with so much power that seem to make the mind surrender some of its precious control. To be in the body so powerfully is terrifying.
I'm thinking it might be helpful in these weeks following birth to support her in the process of integrating body and mind in what she did in birth, noting how wonderful her body was, trustworthy, competent, etc. and how in the midst of such powerful sensations (using an epidural as her tool) she managed them and succeeded. Good for her!! Another baby safely here! Congratulations to all of you involved.

[cathicog]

Bet it makes you wonder how they are as mothers, huh? :

[mwherbs]

whew-- she did pull off a vaginal birth. excellent support on your part.

[Mamajamz]

Bet it makes you wonder how they are as mothers, huh?

The hope is that the life-changing power of birth will impact her parenting in an equally positive way. Whatever the case this mom needs an extra helping of love and support and positive affirmations flowing her way.

[doctorjen]

Mamajamz, I think you are right on about not being able to trust any sensation. In early labor, this lady was so frightened, and I would say (and not in a confrontational way) "Are you hurting now?" and she would say "No, but it's going to hurt" and I'd try to get her to see that all she needed to do right now was deal with the non-painful sensations she was having. In her case, part of being able to deal with early labor involved a promise from us (me and the nurses) that pain relief was available when she did have pain - but I was surprised at how uncomfortable with any sensation she was.
The next day, I usually sit down for a while and let a mama just talk about her birth. This mama mentioned several times that she couldn't have done it without the epidural - and I pointed out that she was 9 when she was checked shortly after getting the epidural, and pushing shortly thereafter, and the epidural didn't work well for her during pushing. She practically did it without an epidural! I hope to help her to realize that she birthed her baby on her own, and that her body was strong and capable. She seemed stunned to realize that she had done it! We'll see how she feels in a couple weeks.

[cathicog]

congrats on being able to help her have what was for her, a positive experience...I can't help thinking though, if she had abuse/rape issues...but she is a happy camper, so that is what counts, and maybe she will change her mind about more children!

[Yummymummy74]

Originally Posted by onlyboys

Jen thinks her client will certianly have an epidural, but she's concerned about the possibility that the epi will not take effectively, and then she's left without recourse for coping with labor. Also, the client *will* have to tolerate some labor before getting the epidural.

I agree with you, though, in cases like this, the epidural is a compassionate intervention.

Why *will* this client NEED to tolerate labour before an epidural? I have had in the past, totally medicated PAIN FREE induced birth.. got an epidural at my request before a pit drip was even started..felt nothing not so much as a twinge.. and it was not a fluke I did this a few times. ( I refuse to birth near a hospital unless I am totally medicated cannot deal with hospital stuff AND labour).. at home alone in my own domain labour is almost pain free for me.. anyhow I digress....

I can say epidurals depend on the person giving them and the drugs used.. dr jen what is used at your hospital? if its the walking epidural variety those IMO are crap.. I have walked out of an induction process before because I was not happy with the level of sensation I had from the epidural...and the anesthetist on call could not make it right.

You can help her get what she needs I am sure.. what kind of epidurals are used in your hospital? I know that some take better than others.. but they can be redone for proper pain releif really it comes down to a womans right to birth how she wants..also some anesthetic/ narcotic combos work better than others... if she wants drugs they should be effective and on her terms.. JMO