Thursday, January 8, 2009

Time frames for birth

This is from a HypnoBirthing homebirth midwife, Jenny West, in New Mexico who really knows her stuff...regarding a discussion about time frames for birth:

In New Mexico our guidelines say the time frame for 2nd stage labor is 2 hours for multips--experienced birthers & 4 hours for primips--first-time birthers.

Now all this begs the question of how many vaginal exams/VE's are being done, because--technically--no one should know when a woman is exactly 10cm's! I wait until the mother feels grunty before beginning to think about charting second stage. Usually, the mother is 10 cm's when she has that little shot of adrenaline that makes her restless, wants to change position, wants to go home.... if she is not at 10, then she is at 8 or 9 and just support her and assure her she is fine (we talk about this as a hallmark of labor progression as well in HypnoBirthing class).
We need to be offering the idea of refusing to be checked all the time--the nurse or midwife can then chart that the 'patient' refused VE. By watching the body language of the mother, I usually know where 'we' are.
My clients usually fall into to two categories of WANTING to be checked: right when I walk in the door--because they want to know all this focused breathing is worth something......OR having that first downward sensation-it all feels so different from what has been happening up to then I'm constantly amazed at how low the baby's head is when Mom has the shift in surges, and so thrilled that she has breathed the baby under the bone without causing any 'fetal distress'--medical birth term, meaning that the baby's head is so squished that the oxygen supply is less and the baby's heart rate is less, or falters at this part of the labor progression. In fact, nurses count on seeing this on the monitor so they know when to 'magically' appear bedside and start the stress and pressure to push your baby out! I rarely see this anymore, even with mothers built like ten-year-old's and a baby that is over 8 pounds with a nuchal hand!
So, some of this begs the question about charting--so no one is too far outside their protocols....Since I'm being 'refused' a VE, I have to chart that and what body language I'm seeing. Once you look at what the mother's body and breath are doing, you don't have to check. Now, I get to do all this in a relaxed, safe, private, un-observed environment----the mother's home and in the water. It might be more difficult to observe these things in a hospital room, but not impossible. Set up the suggestions to clients that they are safe, private and un-observed no matter where they are. (this is why many women want to be in the shower or bathroom when birthing at a hospital--trying to 'cave', to get away to somewhere more private than the merry-go-round hospital bed!)
PS most of my clients have a 2-10 minute "pushing" stage because you wait until the body asks for more help than just breathing. Just had a grandma ask if her daughter was too relaxed and that was why she didn't have the urge to push... the misinformation is soooo ingrained. I told her that there was no such thing as too relaxed and it just wasn't time to bring the pushing idea into the room. Her daughter was having that 'I can't get comfortable, changing position with each surge' part of labor and I know the urge to grunt/bear down was right around the corner for this particular client!

Albuquerque, NM

Thanks for sharing your wisdom, Jenny!


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