Elaine’s Story, Part 2

Hospital Maternity Ward Hallway

Throughout the years, I’ve worked with many amazing women and families. I’ve noticed some trends come and go, and others stay. I’ve become very quick to recognize what is “normal” – which has a very broad definition – and what is beyond a normal emotional and physical recovery. Unfortunately there are many beautiful families who suffer in silence when things are beyond “normal” because they aren’t aware of what to expect and aren’t aware of available services. In order to explain how we help, I’d like to paint a picture; and in order to honor confidentiality, I will combine several client experiences and refer to the client in this example as “Elaine.”

We met with Elaine at the appointed time for our prenatal meeting and asked her to share with us her expectations in detail. She began by telling us a few of her goals, and when we asked exploratory questions, she elaborated. Although the plan she shared with us was a beautiful plan, it was not likely to be one that would come to fruition at her chosen birth place.

Elaine wanted a water birth, but we were familiar with the hospital policy regarding laboring in water: yes, laboring in the tub was acceptable but only if her membranes had not ruptured (her water had not broken) and she would not be allowed to birth in the tub. In order to birth in a tub, she would need to have a home birth, assisted by a midwife. Without bias or judgment, we asked whether it was more important to Elaine to birth with this particular care provider or whether it was more important to her to have a water birth. She indicated that she felt better about birthing in the hospital with the care provider she had chosen, so that was the plan we all moved forward with.

We spent some time identifying which items in the birth experience were high priorities and which were negotiable. Knowing that unmet expectations are a key factor in traumatic births, we needed to gently help her align her wishes with a realistic understanding of her birthplace and help her communicate her expectations clearly to her husband and her doctor.

We take great care to include each participating family member in the birth planning so that we can help birthing women establish a unified family plan. So we also asked her husband about his preferences and expectations for the birth, and found that he felt much more comfortable in the position of a “birth partner” than that of a “birth coach,” – solely responsible for his wife’s comfort. We assured him that we would help him to participate in the birth at his comfort level, giving suggestions of ways to be supportive to his wife, and providing support to him as well.

As Elaine became comfortable with us, she disclosed a history of previous abuse. We responded by thanking her for trusting us enough to share her history with us, and we assured her that we have the highest respect for her and anything she chose to share with us would remain confidential. We did alert her to the fact that because of her previous experience, there are some parts of the birth and hospital experience that can re-open healing wounds.

To help her strengthen her relationship with her care provider, we urged her to write down any questions she had for her doctor about what circumstances with this birth might necessitate a repeat cesarean, as well as what might have caused fetal distress in her first labor.

We also asked if there were any phrases or words that we should not use in her labor, and encouraged her to share those phrases or words with her doctor along with any requested substitute phrases. For example, instead of the doctor saying, “Open your legs” perhaps she could say, “Please lower your knees.” Then we discussed an action plan for steps that she can take to help her feel a sense of control, should this birth plan change.

One week prior to her expected due date, Elaine called to say that she was experiencing painful but infrequent contractions. She knew it was still pre-labor, but she had gotten so anxious that she wasn’t able to sleep for two nights in a row. She couldn’t stop worrying about the uterine infection that had been the catalyst for her previous cesarean, and now she was showering 7 and 9 times a day. She was frustrated because she knew that showering wasn’t going to prevent a uterine infection, but she just couldn’t stop showering.

Recognizing her compulsive behavior and a prodromal labor pattern, we suggested that she talk with her care provider about Therapeutic Rest, a physician monitored sedative that will often result in a more balanced frame of mind and an actively progressing labor. We also offered the option of hypnotherapy to help with relaxation. She called her doctor who recommended Benadryl, which worked quite effectively at helping her relax and sleep.

She woke in a balanced mood and an effective labor pattern. We joined her at the hospital and she labored for 6 hours with an Epidural. Baby was born with high APGAR scores, Elaine’s husband was able to be present for the entire birth, and the family was given time to bond with each other for the first hour (the Golden Hour) before any of the standard newborn care procedures were done.

We returned the following day for a short 1-hour postpartum visit to ask if she had any questions about the birth experience, but she was so ecstatic to be holding her baby after achieving the vaginal birth after cesarean (VBAC) she had planned that she couldn’t think of any questions.

Twenty-four hours after the birth, we met Elaine and her husband at their home for the first postpartum shift. We had discussed her expectations for the postpartum time and knew that keeping the family schedule as close as possible to normal was a high priority. Her husband had some weighty concerns that he wanted to discuss.

To Be Continued . . .