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Do you know this old joke? “How do you make God laugh?… Answer: Make a plan.” Nowhere in life is this lesson-within-a-joke more applicable than with the birth of a child. Birth plans are something I had never heard of until about ten years ago. I believe they are a manifestation of the Internet with its ability to spread information (as well as misinformation) around the world in short order. Birth plans are touted by the non-medical, non-scientific community, such as lay midwives, doulas and bloggers. Most OB-Gyns will say, “Sure, if you wan’t to make a birth plan, I’ll do my best to abide by your wishes.” In my experience, it’s fairly rare to see the labor of a woman with a birth plan go as planned. More often than not, hardly anything goes according to the plan. This is because God (or nature / fate) is in control of what is going to happen and the laboring women are at the mercy of these divine powers. We as doctors can make our meager little interventions, but the grand scheme of things is still outside of our realm of influence.
I guess the whole point of this post is; go ahead and construct a birth plan if you so desire, but please be advised that in so doing you are probably taunting God and things will not go as planned. Also, medical people will be professional about it, but they will be secretly rolling their eyes in their minds, because they will have never seen a birth plan actually work.
I do submit to you today my recommended birth plan. It’s based on the plan I follow in my dealings with other doctors when I am their patient.
1. Do what my doctor(s) think I should do and follow their recommendations, because they have many years of science-based training and experience. They have seen what works and what doesn’t work. They have formed habits and practices that keep their patients safe from harm.
The video we made of me placing an epidural should go over 1000 views in the next day or two and it’s only been up for about 6 weeks. I am encouraged by the amount of interest the viewers have shown.
Many women who are having a baby for the first time are frightened of the prospect of having an epidural. Some have heard frightening stories from friends and family members. Others are just afraid of needles. Whatever the reason, many women are scared the first time. Once they decide to go ahead and have the epidural and have it placed, they almost always say, “That wasn’t that big of a deal. Heck, the I.V. was worse.” By the second time they come in to the hospital for delivery, they are not scared at all. In fact, they are often saying something like, “Epidural, please,” when they walk through the door.
The risk is very minimal and the benefit is huge; no pain.
Some women are ideally suited to have babies without anesthesia. They are generally highly motivated, focused and tough people. They are willing to withstand the pain in order to experience childbirth the way God originally designed it. This, however, does not describe the average woman. The majority of women want very much to have artificial measures used to decrease their labor pain. That usually means an epidural.
In spite of the fact that the majority of women want epidurals, there is an almost cult-like undercurrent in the population that tries to make women feel ashamed of themselves for wanting to labor without pain. The Cult of Pain is what I call all the people that try to convince, scare, shame or coerce women into not getting epidurals. I am obviously biased. I make my living from women who choose to have labor epidurals. Conversely, there is a large group of people who make their livings from women laboring in pain. This group consists of midwives, doulas, owners of birthing centers, people that teach, blog and write about “Natural Childbirth”. Omitting an epidural doesn’t make childbirth natural. True Natural Childbirth means delivering your baby in your bedroom or out in the pasture without any help except your family. If you deliver in a hospital you will have electronics, tubes, catheters, and IVs attached to you. Even in most birthing centers, electronic fetal monitors are used. There is nothing natural about all of that. That’s why I think we need a refinement of the naming system for labor. A woman who delivers a baby without a labor epidural should not be said to have had “Natural Childbirth” but rather “Painful Childbirth” or “Childbirth Without Anesthesia.”
I believe that there is no one-size-fits-all way of giving birth, even though that’s what many books and websites try to tell expectant mothers. If I were designing the ideal birthing center I would actually offer several options, but I consider the availability of the following services to be absolutely critical for safe and satisfactory labor and delivery.
I. Availability of Emergency C-section
I have seen enough death now to know that it is still best to have your baby where there is an operating room and an experienced crew readily available. No matter what any of the “natural” childbirth organizations say, it is crystal clear that if a woman chooses to deliver at home or in a birthing center that does not have emergency C-section capabilities, she and her baby are more likely to DIE!!! Every woman considering delivering this way needs to be informed. If you sky dive, fly your own plane, climb mountains or ride motorcycles frequently, you may be quite comfortable with the increased risk. However, if a woman has had a C-section in the past, then the risk increases so dramatically that it is absolutely reckless to deliver in such a setting.
II. Availability of Anesthesia
I believe that in this modern era, every laboring woman should have the option of a labor epidural, because labor really hurts. No woman can know just how much it hurts until she has experienced it for herself. No amount of planning or childbirth classes can fully prepare her for it either. I have seen literally hundreds of women change their plans from “natural” to epidural after finding out just how painful contractions can be. In fact, in our institution where epidurals are available, the majority of women having their first babies and planning to go “natural” actually change their minds and get epidurals. So my basic belief is that a woman wanting to go “natural” should be afforded every opportunity to do so, but the option to have an epidural should be left open in case labor turns out to be a whole lot more than she bargained for.
Dr. Bob’s Birth Center – Three Options for Labor
No, I’m not talking about delivering in your living room in a kiddy pool filled with organic water from a Himalayan stream, attended only by a tribal medicine woman and 47 of your best on-line friends. I’m talking about using tried and true techniques as promoted by the Lamaze organization (lamaze.org). Although the Lamaze spin is decidedly against anesthesia, their arguments are evidence based, meaning they are backed by proper medical studies. That makes them very different from many of the plentiful “expert” websites promoting their off-brands of “natural” labor.
Basic Principles of Lamaze
- Avoid Being Induced – They recommend waiting to go into labor on your own rather than being induced, (unless medically necessary to protect the safety of the mother or baby).
- Keep Moving – Being up and active as long as possible during labor and trying multiple positions to find the most comfortable one, changing positions often. This may mean not having fetal monitoring on all the time and not having an IV. Epidurals are avoided if possible to maintain mobility. Patients are encouraged to deliver in whatever position feels most comfortable.
- Constant Emotional Support – Having the father or other support person, (possibly including a paid labor companion) constantly with the patient to provide encouragement and emotional support
- Breathing Techniques
I believe some women are well-suited to this method of dealing with labor. My impression of the women that do well is that they are generally physically fit, self-motivated, determined and mentally tough women. Being well-trained ahead of time by a competent “natural” labor instructor is important. Being thin and in shape is ideal. Women who are overweight and out of shape can have a much tougher time pushing babies out. They often just don’t have the stamina.
2. Standard Modern Hospital Delivery
This is what is now the standard delivery with constant monitoring of the baby, IV for fluids and pain relief if needed and an epidural if the patient wants one. All the tubes and wires tend to encumber the patient and the epidural may make the legs week, so the woman is pretty much confined to the bed and usually delivers on her back. This is the method chosen by most women because it is safe and fairly comfortable with an epidural.
3. Elective C-section.
If I were a young woman today coming in for my first delivery, I would pick this option in spite of the increased statistical risk of death and infection. Why? Because (a) it’s a small statistical risk and (b) I am selfish and I am a chicken. I wouldn’t want to deal with the hours of labor, even if I had an epidural. I wouldn’t want that baby messing up my personal parts. I would want to keep them just as they were. I wouldn’t want to pee myself when I laughed. I wouldn’t want hemorrhoids and I wouldn’t want my sex life to suffer. Now, if I were a member of the American College of Obstetrics and Gynecology, they would probably kick me out for even mentioning all this. Certainly the “natural” crowd would think me to be a close relative to Satan. With all that said, I have met many women who agree with me and would choose this option for themselves, if it were available to them.
Dad in the Room?
The Dad’s Role in Delivery When I Was Born
We’ve all seen the old movies where the expectant fathers are in the waiting room nervously pacing and smoking. That’s the way it was when I was born some 50 years ago. Somewhere in the Lamaze era of the ’70s that all changed and the fathers started staying in the room for delivery. I was in the room for the delivery of my two daughters and it was a wonderful experience. I would recommend it for any father. I loved those little girls from the moment I first saw them. I think it’s great for the dads to be in the room for delivery.
Now We Let the Dad’s in on Almost Everything
Somewhere along the way, the dads began staying in the room for the placement of epidurals as well. Shoot, that sounds like a good idea having Dad in the room to comfort and console Mom through the somewhat frightening, if not painful procedure of epidural placement. Yes, it seems like a good idea, but it can be dangerous for the father. Why? Because fathers often pass out when observing labor epidural placement. And how did this “Cut the Cord” stuff get started? Yuck! That’s what those people in the surgical gowns are for. Have you ever gotten amniotic fluid on you? It smells awful. Sorry, I digressed a bit.
10% of First-time Dads Get Lightheaded
I haven’t done any controlled scientific studies on the subject, but my observation has been that about 10% of first-time dads get light-headed at some point during the placement of epidurals. About 1-2% will pass out cold. I know it makes great “America’s Funniest Home Videos” when some guy passes out at his wedding, but when a guy goes down and hits his head hard on the delivery room floor, that’s bad. Following the trend of the day, I used to allow the fathers to stand in front of the moms who were sitting on the sides of their beds. That way the mom could lean over and rest her head on Dad’s chest. That position was optimal for placement of the epidural because it opened up the space between the spines making the placement easier. The father was there also providing both physical and emotional support. The only real draw-back to this system was that every now and then, one of the dads would hit the floor, sustaining varying degrees of trauma. Sometimes I would have to stop what I was doing and run around to the other side of the bed and catch the poor guy’s head before it hit the ground. The usual case was that the only injury the guys would sustain would be to their egos.
Funny Stories About Dads Passing Out
There were actually some pretty funny stories from this era in my practice. My favorite is the time when I was right in middle of putting in the epidural. I had the needle in the lady’s back, when she started slumping down more and more and started saying, “Honey?! HONEY?!!” What was happening was that her husband had feinted and was sliding to the floor. The problem was that his chin was on top of her head and he was pulling her off the bed with him. She would have gone head first but for the valient action of the nurse who was able to break his fall while propping the expectant mom back up on the bed. No serious injuries occurred, so it produced a nice, funny story that the family could tell for the rest of their lives. I’m sure she has told it much more often than he has.
The Epidural Can Be More Dangerous for the Dad Than for the Patient!
Then came the day that Mrs. Jones (not her real name) asked for my services. Mr. Jones stood in front of his wife and steadfastly supported her weight, helping her curve her back outward to provide me with optimal conditions for placement of the epidural. The placement was not as easy as usual, so Mrs. Jones did experience some degree of discomfort during the process. About half-way through, Mrs. Jones began to move in an erratic manor. I looked up and saw the classic “deer-in-the-headlights” look on Mr. Jones’ face. I knew he would soon go to ground. I stopped what I was doing and hurried around the foot of the bed in an attempt to get to him before he fell. Now, Mr. Jones was no small man, about 6′ 3” and 250. Gravity was not his friend during this episode.
Here I describe what was like a scene from an action movie where the hero is moving in slow motion in a vain attempt to save some hapless victim, all the while shouting, “Nooooooooo!” (also in slow motion). The nurse, bless her heart, did her best to catch Dad, but he outweighed her by 125 pounds. As I rounded the foot of the bed, he hit his head on a door knob behind him. I then half-way dove like a wide receiver attempting to catch a low thrown football. I tried desperately to get my fingers under his head before it hit. Sadly the pass attempt went incomplete. The guy’s head hit the floor and it hit hard. At that point I thought to myself, “Holy @%#&, this guy is going to be brain dead!” He then proceeded to jerk in a seizure-like motion for about 15 seconds, which often happens when someone feints. That really freaked Mrs. Jones out. I put on my best professional face and as I peed my pants, I tried to reassure her that everything would be fine. Fortunately, in a minute or two the guy came around and said something classic like, “Whoa, what happened.” I told him he had passed out and to not feel bad, because it happened to a lot of guys. I don’t know if it worked. He seemed pretty embarrassed. We put him on head injury precautions and prayed. He did fine.
I, however, was not fine. Right then and there I vowed to myself to never witness a scene like that again, so since that fateful day, I have always made the fathers sit in a chair while I put in epidurals. I even prefer them to sit in the easy chair across the room. We will let them sit in a little chair in front of the patient to help reassure her if that is his or her preference, but I have even had one dad pass out and hit the floor while sitting in a chair.
Before all this happened, I had read a story on the internet about a father that had passed out during an epidural. The poor guy in the story ended up with a brain injury and eventually died. I had always thought this story to be an urban legend, but after seeing Mr. Jones go down, I believe.
Fortunately, the dads rarely pass out during vaginal deliveries or C-sections. It’s just the epidurals that get them. Now, be ready the first time you take your kid to the emergency room with a scalp laceration, but that’s another story.
Hello and welcome to EpiduralBlog. The purpose of this site is to educate women, families and loved ones concerning the anesthetic options for childbirth. We two authors are a husband and wife team of board certified, MD anesthesiologists who specialize in obstetrical anesthesia. Between us we have done in the range of 5,000 – 10,000 labor epdiurals and other anesthetics for childbirth.
Here are some of the subjects we will be addressing.
- Spinal Blocks and Saddle Blocks
- Anesthesiologists vs. CRNAs (Nurse Anesthetists)
- Why You Shouldn’t Eat Before Surgery
- A Rational Alternative to Obamacare
- Suggest a Topic by Leaving a Comment