Friday, January 30, 2009

Stay at Home!

Even though we thoroughly discuss the benefits of staying at home in labor during birth classes, I would say at least half of the families I talk to after their babies are born make a comment about how either the mom or the dad wanted to leave for the hospital early and had to be talked down.

This isn't surprising, really. There's trained help at the hospital or birth center. It seems to make sense to get there sooner than later: mom can "get comfortable" in her birth space, right? meet up with her doctor or midwife, yes? there will be nurses who can provide some labor support... the car ride will be easier to handle in early labor etc. & etc.

Plus - and I think this is the biggest one - sometimes there is a little blood in early labor, and that, frankly, freaks some people out.

Who mom chooses to attend the birth, where she plans to birth (hospital, birth center, or at home! then you really could stay at home!!), the support she has, and how well she's communicated her preferences ahead of time all play into the mix as well. But even in the best scenarios, it turns out there are some good reasons to stay home through early labor and into the beginning of active labor.

Let's take a second look at those reasonable-sounding rationales for high-tailing it to the hospital, like they do in the movies:

First: the doctors, nurses and midwives are trained, yes. But mostly what nurses and doctors are trained in is managing labor, and looking for problems. Care providers who trust the process, are women-centered, and make few "routine" decisions (as in, routine IV; routine continuous monitoring, etc) are more likely to let mom labor without any inteference. Otherwise, as I've heard it described, "you get on the train and you go for the ride". In other words, once mom gets to the hospital, she's on the hospital ride, more or less. Usually, a shorter ride is easier on mom and baby.

Second: if "getting comfortable" means getting hooked up to an IV and continuous monitoring, then yes, by all means: go to the hospital and "get comfortable"! If your idea of comfort is wearing your own clothes and eating when you want and not answering questions about your pain level and lying in your own comfy bed or petting your cat or dog or taking a stroll in your garden and enjoying the sunshine: well, then, stay home for a little while longer.

Third: Most doctors come in when mom is ready to start pushing or give birth, though they might be in/out to check mom too. Midwives may be present for more of labor, or they may not - depends on the midwife and/or her schedule.

Fourth: Most nurses are there to check on mom - ask questions and assess progress, but do not rub backs, hold hands, or make lots of suggestions re: comfort techniques. I think most nurses would like to do more of this, but the realities of understaffing and charting makes this less a part of their job than they would like.

Fifth: the car ride... yes, that one's valid! But weighed against all the others above, plus what's below... mom may decide it's worth the extra discomfort in the car, after all.

According to the Lamaze 34 week e-newsletter, when mom gets to the hospital actually affects her likelihood for birthing vaginally vs. via surgery:
"Can we safely lower the cesarean surgery rate simply by admitting women to the hospital later in labor? Research conducted on more than 40,000 births in California suggests strongly that the answer is yes. The research team compared the cesarean rates in low-risk, first-time mothers in 20 different hospitals. They calculated the number of women in each hospital who were admitted before they reached 3 cm dilation. After taking various other factors into account, they found that hospitals that admitted many women before 3 cm dilation tended to have very high cesarean surgery rates, while those who didn't admit many women before 3 cm tended to have low cesarean surgery rates. The babies born in the high-cesarean rate hospitals were no healthier than those born in the low-cesarean rate hospitals."
Source: Main, E. K., Moore, D., Barrell, B., Schimmel, L. D., Altman, R. J., Abrahams, C., et al. (2006). Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. American Journal of Obstetrics & Gynecology, 194, 1644-1652.

Also, don't be afraid to be wrong. Maybe you think this is it, pack up, load up, get to the birth place and discover the contractions have stopped and progress is not being made, and/or you're 3 cm or less dilated. As long as you & the baby are doing fine, think about going home. You can always come back! And hey, me - the trained childbirth educator, second-time mom - I didn't get it right and did the whole rigamarole of calling husband home from work, MIL to stay with my daughter, pack up, load up, drive forty minutes to the hospital thing to find out: my contractions had stopped and I was not. dilated. at all. A little bit of squatting and walking to be sure I couldn't get the contractions to come back (after all they'd been five minutes apart for four hours) and then some crying, and I went home. Owen did come out eventually, short easy labor, yes, but two days later.

Finally, do keep in mind that there are good reasons to leave for the hospital before the 4:1:1 suggestion I make to clients (contractions four minutes apart, lasting a minute, for one hour)... for example, a snowstorm; or living further from the place of birth; history of fast labor, or labor progressing quickly. Or, if mom feels like something isn't right, has a lot of bleeding, or a lot of pain between contractions, then it's time to head out right away.

I like how Dr. Sears puts it in The Birth Book: "For most mothers the best odds for a safe and satisfying birth come with laboring at home as long as possible. Presenting yourself at the hospital too early may give you a case of performance anxiety. Soon after check-in the clock starts ticking and the pressure to progress begins. Early arrival opens the door for questionable interventions that may shake your confidence and slow your progress. Also, you're no longer queen in your castle, but a 'patient' in someone else's domain. The house rules are not yours" (214).

So: don't let "bloody show" scare you to the hospital. It's a good sign - the capillaries (small blood vessels) in the cervix are breaking as the cervix thins and opens. Labor has started, or will start soon: but be patient and hang out at homoe a little longer, as queen of your castle.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Anonymous Anonymous said...

Hmm... I never thought about what might have happened with Owen's birth had the hospital/husband/yourself insisted on you staying at the hospital after the 1st trip... eventual pitocin? failure to progress? c-section? Good for you for knowing the difference, as hard as it was at the time (I remember that phone call!) to go back home, it was the right choice.
If I could change only one thing about Natalie's birth (okay, the first would be finding a different careprovider) but the second thing: it would be absolutely staying home much longer and after getting to the hospital at 2-3 cm, going back home.
Although, also coming from the woman who thought Wesley was going to be born in the car on the way to the birth center... a car ride in transition while completely trying control those involuntary pushes isn't ideal either. What would've been ideal both times, for me, would be staying at home for the entire birth!

January 30, 2009 at 7:22 PM  

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