Wednesday, March 5, 2008

need solid advice or stories asap

Not all the way ready to start a big freak-out yet, but I need your help:



I am facing the possibility of a hospital birth with Continuous EFM. So the question is: How in the @#$% am I going to do this without an epidural?



My life has given me the opportunity to really know only 2 kinds of pain management: Moving and moving and backrubs and showers and crawling around on the floor biting dining room chairs...or spinal anesthesia.



I know epidurals can be really bad...I have already been there done that with my 2nd baby. And my 4th. But for Petes sake, does someone actually have any stories about sitting there in the bed and just going through that? Do I double up on the hypnobirthing? DAMNDAMNDAMNDAMN



I promise I will write more to explain what is going on soon....toddler beating the keyboard all day, bartending all night....dishes and laundry to the sky.....no time to blog! Ack!

28 comments:

Judit said...

Joy, halfway through the question I was getting ready to put on my broken hypnobabies record, but I see you're with that program... you'll be okay. The stories are over on the yahoogroup. By the way, you have my personal permission for the pharmaceutical anesthesia should the hypnotic kind not work for some inexplicable reason. But be prepared to be amazed, because it will.
Isn't this situation what telemetry's for, anyway?

JustALittleBit_Me said...

I did it, with back labor, for 12 hours, in a triage room, lying on my side on a gurney with continuous EFM. We took the Bradley method to prep, and I focused on deep abdominal breathing and relaxing my whole body. I think you have the extra advantage of using Hypnobirthing. It can be done.

Just a thought... you could labor sitting up on the birth ball next to the bed or get on hands/knees on the bed or floor.

half pint pixie said...

I had external foetal monitoring (is that EFM? I hope so or this will be a useless reply :) ) And for a while I had the internal bit too only I refused to stay on the bed so the internal one fell out, hurrah! Didn't need either, hospital policy due to being induced... grumble!

But, my point is, I was in active labour for about 8 hours, with the monitor hooked up, bouncing on my ball at the side of the bed. No epidural, I did use gas&air though, but more to help me focus, it doesn't really help the pain. The midwife took me off the monitor to shower as I neared transition, which really helped.

Anyway, it can be done, it is a bit restrictive (well I only have one baby so I have no basis for comparison, but it stunted my "active birth" plans a little) but by bouncing on the ball and just sitting on it rotating my hips, I had no need for the epidural.

Best of luck!

vbacwarrior said...

I found this today and thought it might help you.

http://www.associatedcontent.com/
article/
638277/if_you_have_to_labor_in_bed.html

Jill said...

Oh, crud. I don't really have any advice anyway, but I'll wait to see what you expound on.

This is a worry of mine if for some reason I have to VBAC in the hospital (unlikely thus far). At my next appointment I plan on asking if they do continuous EFM for VBACs, I know some places do. BLARGH.

The other notes give me hope that you aren't doomed, though. Haven't BTDT myself, but it sounds like there are ways to make it work!

Rixa said...

Insist on telemetry (wireless monitoring). If they say they don't have it, insist they buy a unit!

Is continuous EFM a hospital policy? Is is something you do want, or something you'd prefer not to have? In other words, is it something you want (or don't want) to decline?

Housefairy said...

Hi everyone...yeah, EFM is external Fetal Monitoring. I know I havent gone all into the whole "Whats up with no homebirth??!" story yet, but I appreciate these ideas more than you will ever know! I LOVE the ideaof birth ball, and Rixa I will totally look into telemetry.

I am NOT being induced, but for the VBAC in hospital thing, which is rare rare rare to even be "let" to do this, they do want the EFM's on for the hearttones in case of rupture. I am really wanting to look into the whole hypnosis stuff within these new parameters, but got scared with my memories of the tubes and straps and immobilization....shudder

anyhow, keep the ideas coming and I will explain more ASAP
XOXOXOXOX
Joy

Amber said...

Joy,

I'm not a Mama myself, but hopefully in a few years, when the student loans are under control. But I'm the product of a Mama who had a hospital birth with no pain meds. She had me, and later my two brothers, one of whom what induced (and had an episiotomy without even knowing about it till after), and both of whom had EFM, with no pain meds whatsoever. With me there were no interventions at all because she laboured at home for most of the time so I was born within 30 minutes of getting to the hospital. I was also her first baby.

So while I can't give you any personal experience, it can be done. She says you just have to get into the birthing zone. Do what you need to do to get to labourland and don't let the OB and nurses scare you. I'm not saying it won't be hard, but you can do it.

Amber

Sheridan said...

I will say that Hypnobabies is different than HypnoBirthing. I used HypnoBirthing with my first VBAC with EFM and lost focus after awhile. I used Hypnobabies with my 3rd VBAC also EFM and did great! I will say that my hospital also has telemetric monitoring, so I was able to walk the halls, rock in the chair, etc.

But ended up on the birth ball and laying in bed for transformation. (transition) and did great. You can see my birth video on You Tube.

So if you are doing HypnoBirthing, you may want to check out Hypnobabies for some extra tools.

Hugs!

Sheridan said...

Oh, I forgot to add... you can read over 150 positive birth stories with Hypnobabies at www.pregnancybirthandbabies.com They are broken down into categories, so I imagine most hospital ones include CFM.

Anonymous said...

YOu should read "The Thinking Woman's Guide to a Better Birth"

Anonymous said...

Also, look into the Bradley Method to help prepare you. I had a hosptial birth with out pain meds but I was only in the hospital for 18 minnutes.

Kelley said...

Oh Joy, I'm so sorry to hear that things are not going the way you had planned. I wish I had some magic solution, but I don't so I'll just think about you and hope you are able to make this situation work to the fullest possible advantage for you.

Susan said...

Hi Joy,
I'll admit I don't have time to read all the replies right now, so much (if not all) of this will no doubt be redundant.
Almost every hospital birth I've attended (I'm a doula), my clients have had Electronic Fetal Monitoring for at least some part of their labor (in addition to being on EFM in triage). I'm assuming that you're facing *continual* electronic fetal monitoring? If it can be done intermittently, then *great,* but if there is medical indication for continuous monitoring, I would definitely look into telemetry (they can plug your monitors into a little box which you--or, better yet, your support person--can carry around with you). Most hospitals do have it now, although some use it so infrequently that the nurses are not well-versed in its use. If you know in advance that you will likely need to be monitored continuously, I would talk to someone in advance about making sure it will be available to you. It's a bit of a pain, but it affords you MUCH more freedom-of-movement.
Have you hired a doula (or do you have a very doula-ish friend who can support you during labor)? I really think it's so useful.
EFM is inconvenient, but you can definitely work with it, if it's necessary. And remember that these interventions--EFM, and epidurals, and c-sections, and all of it--are *good* inventions that save lives...they're just grossly overused in our maternity system. So if there is a real indication for something (whatever it is), you shouldn't feel bad ("bad" may not be the right word, but I have toddlers and time is of the essence) if your birth includes the use of some of them. They are wonderful, life-saving things when their use is medically indicated.
I'll be watching for the rest of the story...=) Good luck.

Andrea said...

Hi Joy -- I used hypnobirthing for my homebirth and it was NOT a magic bullet for the pain, so I wanted to caution you not to put too many eggs in that basket. I think it was because I had a four hour labor that came on like gangbusters (contractions went immediately to 3ish minutes apart) and I never got a chance to settle into relaxation. And then I found, like you, that I needed to move around.

BUT, I do think hypnobirthing worked for me, for two reasons. First, it gave me daily practice going into a zone. When it came time for labor, even though I didn't relax and go all zen, I certainly went deep inside my mind somewhere. Second, the class and the process really made me confront my fears, which had to do with more than just the hospital -- I found that I was worried about what my husband would do, what my inlaws would say if I "failed" ("I told you so" and "I feel so much better that you ended up in the hospital"), the witch hunt that my midwife was facing, me running out of energy, etc. This was a bigger picture thing that I dealt with in the hypnobirth class, with the book, and everywhere else it took me in my studying and thinking and dealing. Also there was a part on my hypnobirth cd (don't know it we have the same one?) that says, "I'm prepared for any turn my birth may take." I really thought about this and internalized it, and I think it totally helped me be in a strong, smart place, even as I was zoned out, and as some screwy things happened immediately post-partum (we probably "should" have gone to the hospital, but I had the presence of mind to see that we didn't really need to).

But really, there's got to be a way to make it work specifically for you. If you go the hypnosis route, you might think about talking to a hypnotist about how to deal with immobility. But at the same time, you shouldn't have to deal with immobility. Good luck on this! I see you as one of the women I read about who goes the distance and makes the system change to suit your needs!

Is homebirth out completely?

Andrea said...

Also, one more thought on the hypnobirthing? I remember now, contractions were painful and difficult, but hypnobirthing helped me relax very well in the couple minutes I had between contractions. I think this made all the difference -- I just had to get through the minute or so of pain to get to my nice little relaxation break every time.

Aidan's mom said...

Telemetry SAVED me in the hospital. Seriously. The only thing I was allowed to do on hospital bedrest was go to the bathroom and once a day a nurse was allowed to run me a bath and wheel me to it. My peri added the hot bath everyday to dilate my blood vessels (to help with the PIH). I had 24/7 EFM ordered on me because there was a chance my son could have dipped into a deep decel pattern at any time with the state of my placenta.

Thank G*D for telemetry or I wouldn't have been able to take that bath.

I think the advice is solid...make sure that is what they plan on using so you can be up and around if possible.

Good luck! By the way...thanks for your note over on my blog. It meant a lot to me.

Lori

bree said...

I had twins (induced at 38 weeks) in the hospital... I had constant EFM and insisted that they convert the bed to a chair so I could lean over the back of it. I progressed quickly and they REALLY wanted me to have an epidural, "just in case." but I refused, had a STRONG fetal ejection reflex for the first baby and a footling-breach extraction (peri's arm was in my uterus to the elbow) for the second... yes it was far more traumatic than it needed to be... but I did it drug free and on my terms. You CAN insist on being up. I used Bradley breathing and relaxation and nearly kicked the resident in the face when he decided I needed to be stretched... it wasn't perfect, but it wasn't unbearable... and it worked.

Jen.b.in.az said...

Telemetry is a great idea - but what about agreeing to a 20-minute strip per hour, instead of continuous? You could quote the research that continuous montitoring is no more effective than intermittent...but at the same "allow" them their stupid strip every 20 min? Unless it's for your own comfort level, I would think you could simply insist on this. I assume you've already considered having a doula with you?

Navywifeandmom said...

With my one and only hospital birth, I had the initial 30-minute EFM strip and then 15 minutes of intermittent monitoring out of every hour.

Anyways, when I had the initial 30 minute strip, I was leaning over the birth ball kneeling on the floor and the nurse just got down on my level and put it on me where I was kneeling; she NEVER made me get on the bed; it was great. Because kneeling on the floor with my face pressed into that birth ball was where I wanted to be!

It might be more convenient for them to keep you in bed, but you do NOT have to remain in bed on a fetal monitor. They might have to get creative, but it was worth it to be able to be a bit upright for that initial strip.

I really hope, since you are facing continuous monitoring (nope, never faced THAT yet) that you will be able to get your paws on a telemetry unit.

Nicole D said...

Another thing that no one mentioned that I saw (could have missed it) - CEFM does not mean that you can't be on all fours. I was on all fours with CEFM with my twin induction. They said they kept loosing the FHTs and I said 'good, you are earning your RN degree' by them keep having to run in and reposition it. :o) lol!

Nicole D said...

And, I am so sorry that things have changed but what an AWESOME thing that you are able to work with this information, internalize it, and still make it YOUR BIRTH. I know that it will be wonderful and that you will still rock it!

doctorjen said...

I know this is old news already, but thought I'd throw in my 2 cents as an attender of hospital births. I do intermittent monitoring for most of my clients, but when I was still allowed to do VBACs (and I'll try to stay out of that rant) the client and I often would feel better with continunuous monitoring.
In most cases it is possible to monitor in a variety of positions with a little adjusting - I've had mamas all over our unit in telemetry, and on the floor, in the chair, in the tub, you name it.
I want to be frank and honest with you, though, just in case you run into trouble along the way. Sometimes, with fluffier mamas, or especially just taller, bigger boned mamas who don't carry their babies floating on top of their bellies but more inside, I have a hard time getting any kind of continuous heart rate with even minor position changes. This is not always an issue as often I'm happy to just take the tracing I can get and accept some period of time with the baby on and off the monitor. If it's really important to trace the baby continuously though, and we are having a very hard time keeping the baby on the monitor, or if the constant adjusting is really making the mom nuts, this is a situation where I consider an internal fetal monitor. My unit's telemetry works with the internal monitor as well, and often it means the difference between complete freedom to move anyway they want but still hear the baby and the prospect of being constantly harrassed to get hearttones tracing.
I know many people hate internal monitoring, and the scalp electrode does pierce the baby's skin, but I have in my own practice never seen an infection from an internal monitor, and never seen a baby slow to heal from the small pin prick hole. If continuous monitoring is needed, it does really sometimes free up the mom to be able to move without thinking about it.
(I'm putting on the flame retardant suit in case anyone needs to vent at me.)
Good luck - and I'd be happy to share more hospital tips if you need them down the road!

Housefairy said...

Dcotor Jen, I am not going to flame you at all, I need realistic advice and from you, especially! Thank you!

I dont get how internal monitoring, which I had with my 2nd baby (they didnt even tell me, which was the most upsetting part, the baby was fine, not even a mark, even thoigh it is sad/mean to think about) could afford me mobility? How can you move around with a wire up inside of you and stuck into your baby's head? I guess I just dont get the logistics of the thing. But thank you for the realitry check that telemetry unit might not work for overweight women...sucks but better to think about now than then, you know?

doctorjen said...

The wire is just that - a thin wire attached to the baby's head. No matter how you move, it goes with you - especially if it works with telemetry, which ours do. When you roll, walk, sit, stand, whatever, it doesn't slide around and change position and lose the baby's heartrate because it picks up the heartrate directly by being attached to baby's head. The connector part is attached to your upper thigh with a sticker, and then you just have the cord going to the telemetry unit, just like you do with an external monitor. The only downside is that some units don't have telemetry with their internals and some units are so unused to anybody moving at all that they "don't let you" move. Even if the telemetry doesn't work with an internal, if it's important to monitor and we are having a hard time keeping the external on, mom can still be in any position, even standing at the bedside, on the ball, whatever as long as they don't go further than the cord stretches.
The issue with external monitoring is that frequently it stops picking up the heartbeat everytime you move, and has to be readjusted constantly. This tends to tick off nurses and may also drive the mama nuts because everytime she gets comfy we are there having her move her leg, or roll over, or stand back up or whatever to get the baby back on the monitor.
I'm not a huge fan of internal monitoring, you understand, but I'd rather see a mama able to move freely than confined to her back to get a continuous external tracing. Frequently for my own clients I just accept the more intermittent tracing you get with an external telemetry monitor on, but if I really need to monitor (like if mom is on pitocin, or there have been concerning heart rate drops) and we are having trouble keeping the baby on, that's a setting where I would use internal monitoring.

doctorjen said...

One more analogy? An internal monitor in place is alike having a tampon string hanging out - it by itself doesn't hamper your mobility at all. The issue is that internal monitoring is often a package deal in hospitals with confinement to bed, NPO, frequent vaginal exams, etc., but all by itself the monitor is not confining at all.

Joy said...

Thank you!
So much to think about....i thought it was hooked to another machine. I think this whole thing blows, and I am really having a pout about it all today. But good good information, Dr Jen, thank you for this.

doctorjen said...

It IS hooked to another machine - so is an external monitor. Hopefully, it is hooked to a telemetry unit which you then carry with you (or we hang it on an IV pole and the partner can push it around.) If it can't be hooked to the telemetry unit you can only move as far as the cord allows - still enough to get on the ball, rock in a chair, or stand and lean over the bed, but not enough to walk around.