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thoughts/advice?


Forum: Natural Childbirth

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  #1  
May 9th, 2008, 10:12 AM
Starflyr's Avatar Veteran
Join Date: Feb 2008
Posts: 113
Hey ladies

As the time gets closer, Im still nervous about being able to have NCB. I have all the pieces (doula, birth plan, etc) in place, but the "you have GDM and an abnormal pelvis shape and are at high risk for shoulder dystocia" is still freaking me out, so Im trying to figure out options.

I will talk with my OB on Tuesday again about at least TRYING to deliver hands-and-knees first if it happens (I'll take the Gaskin article with) but Im not sure she'll be open to it, probably due to lack of familiarity with it (though she's been very good about pretty much everything else). She'll probably just reiterate that I can push however I want but for the actual "baby coming out" moment I will need to be in the lithotomy position.

I was thinking, if I do end up HAVING to deliver on my back, I surely dont want IV narcotics or an epi/spinal, but what about a pudendal block (in case I have to be bigtime cut to get the baby unstuck and cathed and all that other fun stuff)? Anybody know of any research on that? It's local bupivicaine and just supposed to deaden the pudendal nerves and not affect the ability to push or walk or anything.

I did some research on alleviating dystocia, and the "traditional intervention" list goes something like this:

cath Mom (ACK! I have a cath *phobia*, here...especially w/o numbing...)

1. McRoberts maneuver
2. Suprapubic pressure
3. "generous" episiotomy
4. I forget the name of the maneuvers (corkscrew is one of them), but putting hand and forearm in the birth canal and manually trying to unstick the baby (they do the episiotomy to facilitate this)
5. delivery of posterior shoulder then trying to unstick
6. the Zavanelli maneuver (pushing baby back in and doing a c-section).

It's an emergency situation b/c usually the cord is compressed and the baby only has so long before hypoxic brain injury starts.

If we get to #3 or higher, Im thinking that would be *extremely* uncool without any type of anesthesia, kwim? I just dont know if there would be time or the ability to actually administer the block in the middle of this situation...

that's why Im kinda freaking out and wondering what to do.

I really dont want to do it just to do it, but if they end up having to cut a "generous" episiotomy and stick their whole arm in my hoo-haw to turn him, Im thinking I really wouldnt want to feel THAT either.

thoughts?

Star
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  #2  
May 9th, 2008, 10:21 AM
moon~maiden's Avatar Cheryl~ birth truster
Join Date: Jul 2007
Location: south eastern Mass
Posts: 13,088
ugh, I wish I had more time to really read this and think. Have you talked with your Doula? What does she have to say?

I thought the Gaskin method was well known, but maybe not with OB's.

Is the bupivicaine a saline shot? That might be a different thing. Whatever you look into, make sure they have it set up or on hand as soon as you get there. I requested the saline shot for my back labor and never got it. They told me I could have it, but it never happened. Still annoyed by that.

I am super busy today, I hope someone else has better info. Check that site I posted givingbirthnaturally.com and see what they have to say. Keep in close contact with your Doula. Good luck!!

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  #3  
May 9th, 2008, 11:46 AM
Husher's Avatar B & E complete me.
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Location: NH
Posts: 10,622
There are a lot of words in there that I don't fully understand but I would definitely think some local anesthesia wouldn't hurt, especially if you needed a big cut. Honestly, I don't see what the difference is from pushing on your back to pushing on your hands and knees. They would pretty much have the same view, wouldn't they? I'm sorry I'm not more help. I really hope it doesn't come down to all of this with your labor. I hope it goes quickly and easily for you!
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  #4  
May 9th, 2008, 12:21 PM
OurSweetLabs's Avatar I LOVE My Boys!!
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Location: South Carolina
Posts: 11,003
I just wanted to say that I had a fourth degree tear and then was cut, at the point that you haver the pressure you don't feel the cut. I did have local anesthesia for sowing me up.
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  #5  
May 9th, 2008, 04:49 PM
Starflyr's Avatar Veteran
Join Date: Feb 2008
Posts: 113
Quote:
ugh, I wish I had more time to really read this and think. Have you talked with your Doula? What does she have to say?

I thought the Gaskin method was well known, but maybe not with OB's.

Is the bupivicaine a saline shot? That might be a different thing. Whatever you look into, make sure they have it set up or on hand as soon as you get there. I requested the saline shot for my back labor and never got it. They told me I could have it, but it never happened. Still annoyed by that.

I am super busy today, I hope someone else has better info. Check that site I posted givingbirthnaturally.com and see what they have to say. Keep in close contact with your Doula. Good luck!![/b]
Good website, thanks for the reply

Bupivicaine is an anesthetic agent, like lidocaine or xylocaine

I emailed my doula (I cant really call her during the day, Im in the middle of my own clinic, kwim?) and her reply has helped some

here's what she said:

Quote:
I will answer quickly. (going out) We can write or talk more if we need.
NONE of my patients are catherized. I tell the patient to pee in the bed if
necessary. My clients always go to the bathroom and pee enough that they are
fine. If not, they pee on the bed and sometimes they pee while pushing. In 8
yrs., I have only seen 3 doctors push this. I tried to get one to stop
saying that she had gone a little earlier, but she didn't want to listen to
me and when she couldn't get anything much out said to me, Oh, I guess you
were right. I think it is ridiculous for people to get a cath as they are
trying to deliver. As I said, it's not done in all the places I have been except those 3.
I have seen the maneuver where they "screw" the baby out. I have seen it
done 3 times with deliveries. One with a midwife and all went successfully.
I do know that the all fours position is supposed to help with that. I have seen videos of those births.
I do not recommend the p. block or local before the birth. I think the p.
block is painful to get and a total interruption to the birth process.
(It is not natural and hurts more at the time.) I think a man came up with that
idea who has never had a baby and others followed. I don't like the local
given before birth either as it causes the tissues to swell and my
discussion with several midwives is that we believe that it may cause more
tearing due to the imbalance on the perineum. I think that I answered all. I
will relook at it later tonight. Enjoy lots of sex, squats and all fours every day and lets see what happens.[/b]
So...I guess we'll see how it goeson Tuesday w/my OB...


still nervous.

Star
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  #6  
May 9th, 2008, 08:13 PM
Husher's Avatar B & E complete me.
Join Date: Jan 2007
Location: NH
Posts: 10,622
It sounds like you have a great doula, Star! I would trust her judgment and avoid anything she doesn't recommend. You trusted her enough to be your doula so I would trust her on this. Again, I'm sorry I couldn't be more help. I hope it all goes well for you and take her advice with the sex, squats and exercises!
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