Coaching women during childbirth has little impact - page 3
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Nov 29, '07I have given birth to seven babies, all with midwives, first in the hospital in 1976, the last six at home. All babies were posterior and lengths of labors ranged from 3 hours to 52 hours total (not counting latent phases of labor).
What worked best for me, frankly, was verbal encouragement; others present respecting my choices for positions, breathing, etc.; and laboring in the water. While laboring in water doesn't obliterate the pain by any means, it usually makes it far more manageable for most women. (We call it the "aquadural.") Experience demonstrates that waiting to enter the tub until the woman is a solid 5 cm. provides good pain relief and tends to accelerate labor, whereas being in water earlier in labor often slows its progress. Water should be comfortably warm (98-100 degrees F); elevated temps can cause fetal tachycardia. Wish more hospital L&D units would consider allowing women to labor in the water; it's certainly not impossible to deal with in terms of infection control, etc.
Nov 29, '07We have huge, beautiful tubs where I work in L and D, and I have NEVER seen a pt in one. We are very "medicalized", have to be strapped to those monitors, and pumped full of pitocin. Man, that sounds bitter, lol. But true! And oh my gosh, don't make any radical suggestions, like walking at 9 cm, just give 'em the pit.
I was in triage one night (I have only been at this hospital for a few months), and a woman came in, was 4cm and ruptured. Give her the gown, a pad, and net undies, and leave to check on another pt. Came back and another nurse was helping her on with the undies. Takes me out of the room and says "we always help them with there clothes while there in labor" in a snotty voice. I had to bite my checks to keep from laughing! If the poor woman couldn't put her underwear on at 4cm, then how is she going to push a baby out at 10cm. Wouldn't that be to much work? Why do we treat women like they are sick, when they are in labor?
BTW, the laboring woman in question was looking at this other nurse like she had two heads, and later told me "umm, I can put my underwear on, I've been doing it for years" I was almost ROTFL. Ok, so that was way off topic, just saying I know what your talking about, nizhoni.
As far as "coaching", I'd say 80% of L and D nurses I know do count to 10, hold your breath, make sure you get 3 pushes in a uc. I tend to go with the flow of the mom, if she is not bringing the baby down with what she is doing, I'll suggest trying to lengthen pushes. I just will not count to 10, unless mom specifically ask me to count. About 90% of the time, what mom feels comfy doing will get the baby out.Last edit by crissrn27 on Nov 29, '07
Nov 30, '07I have to agree...I have had 5 children with no epidural or pain meds. I did a 6 week Lamaze course, with the first, then studeid all I could about different other methods with subsequent pregnancies. I always felt that my birth experiences were spiritual and special and hard work. I always tried to view the contractions as work and not pain...a partnership between my, my baby and God. The KEY is practicing how to handle contractions, but ALSO how to SURRENDER to what the body needs to do. If I have a patient that I can tell is committed to intervention free birht (re: pain meds), one of the most helpful bits of coaching that I can offer is to help them focus on surrendering to the labor process with breathing, guided imagery, massage, whatever may be working for that particular mom. I have seen lots of "plans" go "out the window" but for those that have practiced and have a supportive coach, birth is natural and beautiful. Just my 2cents.
Nov 30, '07I think that the coaching we give to laboring women has more to do with helping them feel more positively about their birth experience than it does with having more physically positive outcomes.
A lot of times coaching helps a woman feel in control. Although it is a natural experience, a lot of women - especially those having their first baby, are terrified. It's all unknown and it's almost always harder than they thought it would be. A few less minutes of pushing is hardly the point. I want my patient to feel like they were supported and encouraged.
As for birth plans... I'm always nervous when a patient comes in with a birth plan. Not because it interferes with our policies, but because it usually doesn't go the way they planned and then the patient is left feeling like her birth experience sucked simply because she ended up needing to be induced for post dates, or having to have a baby code team present because of meconium.
I always feel about a hundred times better when I have a patient tell me she wants to play things by ear. Those patients always seem to leave more pleased with their birth experience than the patients who come in with birth plans.
Apr 10, '08There is so much more to coaching a woman through labor then telling her to push. The coaching starts way before the pushing part. For our second, my husband and I tool Lamaze classes because we planned on having a home delivery with a midwive. He coached me through through breathing and kept me focused. The birth was completetly without any analgesia and I wouldn't do it any other way. The feeling of that baby exiting your body was a wonderful feeling and not just because the pain was gone. I would have done it again the very next week if I could have.
Apr 11, '08When I was pregnant, here was my philosophy:
Ignorance is bliss.
I didn't want to attend a chlidbirth class so I could hear all of the horror stories about everything that could possibly go wrong, long labors, epidurals that wear off, etc.
I personally thought that a few episodes of "A baby story" Discovery health was education enough.
I was planning on giving birth in a hospital, and to me, that was sufficient...I pretty much assumed that someone would be there that knew what to do.
I had a plan alright...my plan was NO PLAN.
Everyone that I knew at the time that had a baby recently, all had a plan, that got thrown out the window.
I packed my bag when I was 7 1/2 months along...people thought I was nuts, "way too early" I was told. They just thought I was being an overly-excited first time Mom.
The very next week I was admitted with preeclampsia, which was not manageable. Twins born by c-section 3 days after admission.
...sometimes I wonder if my "motherly instinct" kicked in early.
Apr 11, '08Quote from earle58What an igmo!!!!oh! when the ob did show up to deliver my baby, i do remember him saying that the pain a woman endures is comparable to a man passing kidney stones.
i took my foot out of the stirrup and kicked his shoulder so hard that he rolled backwards in his stool. still don't regret it.
I have given birth to three babies and had multiple kidney stones. Kidney stones were a breeze to pass compared to an 8 lb 11 1/2 oz baby with shoulder dystocia, even WITH an epidural.
I'm GLAD you kicked him!!!!!!!!!:chuckle
And so far as coaching, I had decided with my first one, that I would go "natural", no drugs, I just knew it was a beautiful experience, blah blah blah. Not to deride anyone else, but all those weeks of Lamaze class went right out the window once those contractions got hard and fast and stayed that way for 15 hours of the 19 hour labor!!!! BRING ON THE EPIDURAL, BABY!!!!! With my next two kids, I wanted the epidural at the beginning of the ninth month!! The nurses did coaching, my exDH was pretty useless, although he at least managed to NOT pass out.Last edit by KaroSnowQueen on Apr 11, '08 : Reason: clarity
Apr 11, '08Quote from LuvMyGamecocksHe couldn't know, but women do get kidney stones and therefore know about the comparison.oh! when the ob did show up to deliver my baby, i do remember him saying that the pain a woman endures is comparable to a man passing kidney stones.
i took my foot out of the stirrup and kicked his shoulder so hard that he rolled backwards in his stool. still don't regret it.
BTW, How does HE know what labor is like?
And what does a man have when he passes a kidney stone? A KIDNEY STONE.
I've heard WAY more horror stories about female OB/GYNs than about male ones. JMHO.
Apr 11, '08
Researchers at the University of Texas Southwestern found that women who were told to push 10 minutes for every contraction gave birth 13 minutes faster than those who were not given specific instructions.
Wow! How did I miss this thread???
First of all, to refute those Texas Southwestern researchers, they have blatant untruthsand without stating the numbers of people who were coached vs the same number not coached (known as a double blind study) there is no validation of their statements!
The blatant untruth, is in regard to their saying that women can push for 10 minutes through a contraction. As anyone who's ever taken a childbirth preparation class knows, contractions in the second (pushing) stage of labor last a maximum of 2 minutes.
If someone pushes longer, she is wasting her energy and exhaustion and the cervical swelling that causes, will lengthen her 2nd stage of labor, cause damage to the cervix (lacerations with subsequent bleeding), and is generally a very poor method, as pushing is effective in helping a baby down the birth canal (vagina) only during the 2 minute contractions characteristic of that stage. Uterine monitoring strips (like EKG readouts, except they also reflect the baby's heartbeat and can show any distress during a contraction that would place the baby at risk) bear out the proof of the length and severity of the 2nd stage contractions.
Any research study, to be valid needs at least 2,000 coached participants, and the same number of uncoached women. The techniques of pushing taught should similar and be well practised. So many more women need to be considered (triaged) for the study, than actually are in it.
The coaches need to work hard to support the women as they were taught, positioning them in various attitudes, and talking them through the 2nd stage's contractions, saying as quickly as possible: "Breathe in, breathe out (or if preferred, doing the 2 "cleansing" breaths with their woman), hold your breath and legs, relax your pelvic floor, keep pushing, keep pushing 1, 2, 3, 4, 5, 6, (to give an idea of how long they've held their breaths)!". Then if the contraction is still there (borne out by her hard abdomen and the monitor tracing showing a raised line for the contraction), the coach immediately says "breathe in" after she has exhaled, and repeats the instructions again as long as the contraction lasts. Usually the impetus of contractions in that stage is so strong, that most women can hold their breath longer than in practise sessions, another reason why it is best to have time to relax.The contractions of the 2nd stage are usually further apart than the earlier ones of "transition", which is nature's way of allowing a short rest period.
The primary goal of a coached childbirth is not the speed of the 2nd stage (or the 1st), but the sense of teamwork and caring experienced by the woman, who can better relax, getting more oxygen to her unborn baby during her labor, which promotes greaterr health.
It saddens me to think the unscientific study referred to, was actually seen by a prominent news agency as valid - if they indeed quoted the researchers accurately.
Apr 11, '08Quote from lamazeteacherActually valsava (breath holding) pushing is harmful to both mother and baby- results in poor cord gases, lower APGAR scores, more fetal distress, and more perineal trauma. More effective "coaching" in second stage would be explaining to mom the mechanics of physiologic pushing and encouraging her when it is performed correctly. Whether mom pushes or not the baby will come out- it is best to avoid exhausting and harmful valsava pushing.hold your breath and legs, relax your pelvic floor, keep pushing, keep pushing 1, 2, 3, 4, 5, 6, (to give an idea of how long they've held their breaths)!". Then if the contraction is still there (borne out by her hard abdomen and the monitor tracing showing a raised line for the contraction), the coach immediately says "breathe in" after she has exhaled, and repeats the instructions again as long as the contraction lasts. Usually the impetus of contractions in that stage is so strong, that most women can hold their breath longer than in practise sessions,
Apr 11, '08Quote from efiebkeI loved your hunor, Ted. Let's add the quote "the best laid plans of mice, men, and pregnant women.........."Interesting.
My most ever loving wife has recently switched departments during her young nursing career. She is now on our happy little hospital's maternity floor eagerly and anxiously learning how to deliver babies. Of course she talks about her experiences to me (respecting HIPPA, of course :chuckle). A couple of mothers, when asked, said that they had no formal birthing plan thought out. There were no formal "coaching plans" for those soon-to-be new moms. Apparently, one mother said that giving birth was "natural" and said that she would just "wing it". (It was her first birth).
Now understand that "I don't know nothin' 'bout birthin' no babies. . . . " !!! But if I was a soon-to-be new mom, I would want a definate plan. But I'm not. Heck, I'm not even a woman. But if I was, I would at least want my husband present, reminding me to breath a certain way while I gave birth to a "watermellon" so that I could scream and yell at him.
Birth plans were conjured in the '80s, and a lot of childbirth educators liked the idea. To me, they're like a cook who use different ingredients than the recipe requires. When you have no idea how the labor will go, it's hard to get fulfilment from a plan. Rather, it's like many wrong answers in the final exam. If my students wanted to do one, I supported them, with cautionary admonishments that they make them flexible for the many different scenarios that can (and will) occur.
I'd much prefer that time was spent practising their techniques so that they are used smoothly, with agreement about which one to use. That can only be accomplished through "conditioning" as Dr. Lamaze described, which requires many daily rehearsals for labor with the coach(es). That's why we wait until the last half of the third trimester, to begin preparation for labor. Fear and imminence motivate practising.
A proactive, energetic coach tuned in to the needs of the laboring woman, who avoids statements like, "you're breathing wrong" and breaths as taught, following the laboring woman's lead, or if she's lost it, breathing so she can follow, is worth his/her weight in gold. Often the lack of sleep and time spent following that runaway horse called labor, makes it necessary to have a spare coach, who might be a "doula", a person trained to assist women in labor (not necessarily as medical professional). :bowingpur
Apr 11, '08Quote from Marie_LPNRather than a "plan", knowledge of the anatomy and physiology of labor will enhance one's awareness of it, allowing informed participation rather than the common fight/flight reaction.I'd want as much of a plan as possible, consindering WHAT is coming out and WHERE it's coming out.