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Nov 8, 2008

Natural Vs. Medicated Birth

Yesterday, on Nov. 7, 2008, I delivered my second son.

My first birth was completely "natural", by which I mean drug free. This post has nothing to do with writing, except to admit that one of the reasons -- perhaps a more unusual reason for wanting a natural birth -- was because, as a writer, I wanted to know how most women, throughout history, would have experienced childbirth. How else could I write about it?

This time I wanted to experience how women in the future would experience childbirth -- perhaps point-to-point transport from womb to incubator? Alas, I couldn't find a hospital offering such services.

In any event, this time I agreed to be induced. (Last time I went a week past my due date, to my doctor's annoyance, waiting for labor to begin on its own). Induction is usually done by administering Pitocin, a drug that simulates the body's natural trigger for labor. I'd researched Pitocin and other birth medications during my first pregnancy. One of the things I read about it was that it created much stronger contractions than the natural chemical, and so usually women who took Pitocin ended up also getting an epidural as well. There are various scary complications which can be involved with epidurals.

During my first childbirth, determined not to get an epidural, I instead used meditation and breathing techniques to deal with the contractions. Originally, my husband and I planned to take Bradley classes. Too lazy, we failed to sign up until the last minute. By then it was too late to take the whole slew of recommended sessions, so instead we paid for a one-on-one session with a Bradley duala. She gave us some techniques, and mostly advised us on good-to-know things like when to go into the hospital (not too soon, with a first birth).

That wouldn't have been enough in terms of breathing techniques, but I fortunately had also had a tiny bit of experience with Buddhist meditation. All very Beginner's Level meditation, mind you, but at least I knew a few simple breathing exercises and mantras. Some hypno-baby tapes helped me with childbirth specific exercises and visual imagery. I was in a trance state, and hardly aware of the passage of time or the arrival and departure of various nursing staff.

My first childbirth was fairly successful, up until the crowning. Well, to be fair, up until the transition. I used focus meditation during the contractions, which felt like my uterus was a wine skin being twisted and squeezed like a towel. I could handle this sensation with the breathing without feeling pain. When I reached transition, I began to feel the overwhelming urge to PUSH. But I was only dilated to seven centimeters, and the nursing staff kept telling me, "Don't push yet! It's too soon! Wait until you're ten!" But I couldn't control the urge. Trying to fight it made it much harder to keep to my trance state. By the time the crowning started and I actually WAS ten centimeters and supposed to push, I was so exhausted I lost all control of my breathing or anything else. I couldn't even coordinate my pushing to the contractions any more. It took forty minutes to push the head out, and the pain crashed in on me, perhaps all the more unacceptable because the first part of the labor had been relatively tolerable.

I didn't want to lose control like that this time. I spent a lot more time in the weeks before the delivery practicing my meditation and uterine exercises. Since I was to be induced, however, I wasn't sure it would be of any use to me. I had visions of the epidural turning my lower body so numb that I would be hardly aware of having legs at all. I also feared the Pitocin alone would create overwhelmingly strong and painful contractions. In fact, the whole business of knowing the date of delivery felt weird and made me increasingly nervous. I went in prepared to have an epidural at the same time as the Pitocin.

However, Faith, the nurse who attended me, said it wouldn't make sense to give an epidural until after the Pitocin started the labor. (The epidural slows contractions and might prevent them from starting up properly if administered too soon.) She said she would start the Pitocin out slow, and if I started to feel overwhelmed by pain, she would call for the epidural -- but it would be better if I could hold out longer.

Ok. I agreed. We put on my trance music. (I resisted my husband's query as to couldn't we possibly play more than just the one song for eight hours straight? Uhm. No.) I did my breathing excercises. It seemed to me that the contractions actually started slightly before the Pitocin drip was set up -- something the nurse confirmed. She set up the drip anyway, and I didn't object.

For the next several hours, though, the contractions were very gentle. Faith asked me to rate them on a scale of 1 to 10, and I rated them a zero. I was afraid that the Pitocin was SO low that it wasn't doing any good at all.

I struggled a bit with boredom, since I was strapped into the bed. I had worried about that; mightn't I want to move about, as I had last time? But actually, holding one position facilitated the breathing exercise. The whole thing was so low key, I was tempted to entertain myself by reading a book, rather than meditating, but something told me not to do that. And when my husband, who was surfing the net on my laptop, began to talk to me about news headlines, I had to ask him not to interupt my concentration. So clearly, the meditation was doing something. In fact, it was working so well, it was almost transparent.

I began to feel the contractions were getting very strong after all. This time, I called the nurse, and asked if she could give me the epidural now. I still wasn't in pain, exactly, but I just had this feeling I should have the epidural soon.

She was a little dubious, perhaps because I was still calm, and warned if I weren't at least 4 cm dilated, we should wait longer. I hoped the stupid Pitocin had done something, and I was at least that much.

She checked me, and went into a panic. "You're already seven centimeters!" She quickly called for the anesthesiologist to come but he was busy with another case.

Then it happened -- just as I had at this point in my last delivery, the nature of the contractions began to change, urging me to PUSH.

"Don't push yet!" the nurse ordered. She called my doctor and told her to come NOW.

Several uncomfortable contractions passed, where I fought the PUSH PUSH PUSH sensation as best I could. Then I had to hold still while the anesthesiologist set me up and poked a big needle in my spine. A few more bad contractions, while I waited for the epidural to kick in. By now I was doing my counting meditation out loud -- "One, two, three, four, five, six, seven, eight, nine, ten...." About three counts of ten per contraction. As I counted, I performed kegels -- this helped me resist the need to push. I don't think the nurse knew about the kegels, but she began to count aloud with me.

Ironically, although the epidural slows contractions if given to early, apparently if given at this point in the labor, it speeds things up. I went from seven to ten centimeters within three contractions. The epidural hadn't really had time to kick in completely. I could still feel the contractions just fine, but the edge was off, I was able to control the amount I wanted to push.

My doctor arrived and told me it was now okay to push. I did. Within twenty minutes, really just a few long, hard contractions, the baby came out. I couldn't believe how easy it was compared to the last one! Yes, those pushes where the head comes out were still painful, and I did have to take a break with the head still half in, half out -- the most painful point -- and the doctor asked to do an episiotomy, to which I assented -- but the next push was sufficient to get him out!

Second births are so much easier, and I was happy with the whole Pitocin/epidural thing. It worked just the way it was supposed to. But my meditation worked the way it was supposed to, as well, which made me think that the whole dictomy between Natural/Medicated birth is a bit silly in the end.

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