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#31 of 53 Old 05-20-2005, 02:02 PM
 
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Like mrsmoe, onlyboys, and norab i agree that epidurals have their place. I think it still makes sense to prepare for birth though. Even if you get a 2nd epi and it does take, it's not like this happens instantaneously. And when you're in out-of-control pain minutes seem like forever.

I like the analogy this article has about birth being like climbing a mountain and how there are different ways to do it and you need to pick the way that's right for you:
www.birthpsychology.com/birthscene/mothers3.html

The relevant passage starts out "Approaching childbirth is akin to stepping towards a mountain range, assuming that what lies ahead is not the ordinary terrain you are used to traveling. "
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#32 of 53 Old 05-20-2005, 02:09 PM
 
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Originally Posted by MrsMoe
If an epidural does not take, they can redo it! My friend who had an epidural (twins delivered vaginal) had to have it redone, twice, so she was stuck a total of 3 times! But it did take, and she says she was so so glad she had it done, even though that had to stick her a few times.
Even with a well placed epidural, the pain relief can be quite variable, not to mention that it can take a while to get relief. They are not going to be able to place it before she feels anything either! She needs to be prepared that even with an epidural, 'no pain at all' is not realistic.
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#33 of 53 Old 05-20-2005, 02:29 PM - Thread Starter
 
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I ordered that "An Easier Childbirth" book. It looks good. I liked the idea of doing a birth inventory - maybe that will help her determine what her issues are. Great ideas so far - keep 'em coming!
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#34 of 53 Old 05-20-2005, 03:37 PM
 
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Sometimes an epidural is not an option--if your lab work is abnormal, if you can't hold still long enough to place the epidural, if it doesn't take (sometimes there is a window of pain; you cna't place an epidural an infinite number of times; at some point you are going to run out of appropriate sites). I think that even if this woman has an epidural, when she goes into labor, she is going to have to deal with the pain for a little bit; you don't present at the hospital and get an epidural within five minutes. You have to check in, get your labwork done, get the IV started. Depending upon who does the IV (the nurse, the IV team), if the anesthesiologist is immediately available, is busy in the ER or the OR, or has to be paged from home, it can be literally hours from when you present until when you get your epidural. I have seen this first hand, I know it isn't even close to instantaneous. I don't disagree with you at all in the sense that epidurals are sometimes very appropriate. I work in an out of hospital birth situation, but I realize that there is a time and place for everything. I used to work with pregnant teens in state custody, and some of those ladies were better served by having an epidural than a natural childbirth. I appreciate that there are situations where an epidural can really help a woman have a great birth experience.

I think also that, even if she has an epidural upon the first moment of pain, it is appropriate for her doctor to be concerned about this all consuming fear. Who knows when this will again present itself, and in what manner? This sounds like a very serious issue, and I agree with all the suggestions--hypnosis, therapy, doula services, etc. I think counselling sounds very much in order here. I would recommend a counselor who has experience in dealing with sexual and birth trauma; some one with experience with rape and sexual abuse, specifically. Even if this woman has not experienced a sexual assault or childhood abuse, the feelings she has are very similar to those who have, and such a counselor might be better able to help her through her fear.

Good luck, Jenn! I feel so badly for her; I hate to think that she is spending her pregnancy full of this barely contained terror, rather than enjoying the growing life within. Poor woman! I hope she finds some reassurance and support that works for her.

Lori
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#35 of 53 Old 05-20-2005, 05:14 PM
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I didn't stop to think about the pain of "before an epidural" because that doesn't even come close to stage 3 labor pain... I know they can administer the epidural at 4 centimeters, but I read a recent article in a Pregnancy Magazine that stated (research from a well known medical university) that past assumptions that administering an epidural too early would slow and delay labor and wasn't advised... the stance is now different and research shows that early epidurals do not slow labor any more than epidurals given later in the birthing process.

I tend to be sympathetic to a degree, but, there will be some pain, even with an epidural, she needs to come to grips with it and prepare herself. There are many good options in the thread, such as a good coach, hypnotherapy, but it is going to hurt regardless, and if she gets herself all freaked out by it it will make the pain even worse. I do also wonder if her fears are that strong if there is an underlying issue?
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#36 of 53 Old 05-20-2005, 07:48 PM
 
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Does anyone have a good link to a brief description of the benefits of doula services?
http://www.dona.org/PDF/EffectsofBirthDoula.pdf

This may be helpful as well:
Quote:
Finding A Non-certified Doula

Doulas of North America gives referrals of all its doula members who want their name to go out to the general public. Non-certified doulas are those members who have not completed Doulas of North America certification for a variety of reasons, including the possibility they have chosen not be certified or they are still completing the certification process. DONA is merely providing a listing of those members' names who have paid for membership. DONA recommends that you ask each doula about her training, experience and for references of previous clients. Referrals are done for a geographic area usually found by city and/or zip code.

Please send an email to Referrals@dona.org listing your city and/or zip code. We will send a list of certified and non-certified doulas in your area.
Who knows, you might get even closer than an hour. And heving her boss read The Birth Partner would be a great idea.

Personally, I have no issue with a woman getting an epidural -- that's her choice -- her birth, not mine, right? That being said, it is wise to allow for the possibility of eith erone not being available, or one not taking effect, so you are wise to counsel her in that matter.
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#37 of 53 Old 05-20-2005, 08:47 PM
 
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nevermind
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#38 of 53 Old 05-20-2005, 09:12 PM
 
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The other thing I was thinking is that even if she does get an epidural and even if it does work well, if her fears are deeply rooted she might still be afraid! And I am sure anybody hanging around here is familiar with how fear can hinder labor & birth.
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#39 of 53 Old 05-20-2005, 09:38 PM - Thread Starter
 
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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!
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#40 of 53 Old 05-20-2005, 09:55 PM
 
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If you find one who is working on certification *keeping fingers crossed* she may do it for free or at a greatly reduced fee. Perhaps more "established," for lack of a better word, married, you know, older...know what I am trying to say? patients would be leery of the thought of a doula, but this mom sounds like she may be open to having a supporter.

You may also consider what kind of support her cousin could be. Perhaps with a little bit of training or support to the cousin, she could be really helpful to the mom.

Let me know if I can help at all -- I don't know if I can, but DONA-wise, maybe I could be of some help.
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#41 of 53 Old 05-21-2005, 01:30 AM
 
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Victorian, visualizing Aragorn/Viggo could get me through a hell of alot of pain, too.
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#42 of 53 Old 05-24-2005, 01:09 PM
 
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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
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#43 of 53 Old 05-24-2005, 01:41 PM
 
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Yeah, if you relocated to my area, I'd be knocking on your office door the same day. LOL
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#44 of 53 Old 05-25-2005, 04:00 PM
 
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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.
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#45 of 53 Old 07-18-2005, 12:36 AM - Thread Starter
 
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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.
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#46 of 53 Old 07-18-2005, 12:48 AM
 
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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.
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#47 of 53 Old 07-18-2005, 02:23 AM
 
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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.
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#48 of 53 Old 07-18-2005, 03:18 AM
 
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Bet it makes you wonder how they are as mothers, huh? :
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#49 of 53 Old 07-18-2005, 10:14 AM
 
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whew-- she did pull off a vaginal birth. excellent support on your part.
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#50 of 53 Old 07-18-2005, 03:33 PM
 
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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.
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#51 of 53 Old 07-25-2005, 01:07 AM - Thread Starter
 
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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.
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#52 of 53 Old 07-26-2005, 01:15 PM
 
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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!
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#53 of 53 Old 07-29-2005, 01:17 AM
 
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Quote:
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
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