More Than Epidurals

The last time I sat down and started writing about Pain medication options in labor it ended up being 3+ pages about epidurals. So, here’s another post about the other options that are available. 

One option is IV pain management. What does this mean? This means that if you choose this option, you’ll have an IV and the medication is pushed through the IV. This is not a continuous thing like an epidural. The medication is pushed through with a syringe over 1-2 minutes. 

The pain medication that is most commonly used is fentanyl, which is an opioid. I know what you’re thinking. 

·      Fentanyl? Isn’t that what Prince died from of an overdose? 

·      Opioids? Isn’t there an opioid epidemic? Why would they give laboring mothers something that’s addicting and toxic to her and her baby? 

Actually, it’s not as scary and dramatic as you think. This plan of pain management is only given once or maybe a few times during the course of labor. The mother and her baby are monitored very closely. Which means, being hooked up to baby monitors on the belly and a pulse oximeter on the finger to monitor your heart rate and oxygen level. 

The IV pain medication is best used when the mother is very tired from laboring for a long time. The medication gives her a chance to rest and take a break. The medication doesn’t take away the pain completely, but it helps a lot and she’s is usually able to relax and maybe even take a nap. There are of course cons to this method. Possible side effects of this include nausea, vomiting, feeling drowsy, and it can affect your baby’s breathing and heart rate. This is why we monitor baby and it’s also why we don’t give this option to moms who are close to delivery. Giving it too close to delivery can affect the baby more after birth because the baby isn’t getting the help from mom on the inside to recover and cope with the medication. Another con is that with each time it’s given it loses its effectiveness. 

Every mom, labor and situation is different. Some of these things sound scary, but it’s not right for everyone. For some, it’s a life saver because all they needed was just some short relief and rest to power through the rest of the mountain. 

The third pain relief option is called nitrous oxide or more commonly known as laughing gas. This is the same drug given to you at the dentist that you breathe in, however it’s given in a decreased concentration during labor and it’s mixed with oxygen. It hasn’t been really used in the United States until a few years ago when it started to become popular. It has been used in a lot of other countries for many years though. How it’s used is you breathe in and out through a face mask or a breathing tube during contractions. The mom is the one holding it up to her face, so she is in control. She can use it or not at her discretion.

I used nitrous in my second birth and I liked it. The best way I can describe it is that it doesn’t take away the pain, but it helps you to cope with the pain.  Possible side effects of nitrous are nausea and feeling light headed. 

There are a lot of pros to using nitrous oxide. If you decide you don’t like it or it’s not helping you, it doesn’t stay in your system for very long, only a few minutes. Since it doesn’t stay in your body for very long and it doesn’t have a chance to affect your whole body, meaning it doesn’t affect your baby. Since it doesn’t really affect your baby, this means no monitoring of the baby. This also means that you are able to move around more freely and aren’t hooked up to anything. Hallelujah!

In my own experience with nitrous, I started using it when I was 6cm, although I would have taken it sooner if we had gotten there faster. (Thanks a lot Steve!) (jk, love you) After using it for a while and I was transitioning to the end, it wasn’t helping me anymore and I opted for the epidural when I got to 8cm. 

FYI to dads and other partners at the bedside, don’t try to take a hit. That’s not cool! You need to be there for her, and she doesn’t have time for you be playing with drugs. Plus, if we find out, you might be asked to leave and given an evil stare. 

So, you can switch from one pain option to another, but will have to wait for some lag time between them and you can’t use more than one at the same time. 

So, there are many different options and scenarios to choose from. All of which are relatively safe. There are pain relief options that are not medications, but that’s for another blog post.

Miscarriage Sucks

Miscarriage Sucks

Did you know that 1 in 4 women have had a miscarriage? Miscarriage is sort of an enigma in women’s health as it is not talked about often. However, it is unfortunately a common occurrence. I see women in the clinic everyday who have had or are currently going through one. It’s heartbreaking to me when I have to counsel a mother about her concerning symptoms, and I’m thinking she’s probably having a miscarriage, but I inform her that she has to go through blood tests or an ultrasound to confirm it. I have to say my nurse schpeel that these symptoms are concerning and we need to confirm it, which takes time. The time it takes to wait is agonizing for them. They don’t know what to think. They’re worried, anxious, but still hopeful that everything will be ok and they read on Google about stories that women out there have had these same symptoms during their whole pregnancy. What’s going to happen to me? What do I tell my family and co-workers that I’ve already told that I was pregnant? Will this happen when I try again next month? 

These are just a few the thoughts and emotions that women are likely feeling. Just recently I became one of those newly expecting mom’s that unfortunately experienced a miscarriage. 

I’ve gone through a complete roller coaster of emotions and feelings within a span of a week. My husband and I had decided we were ready and wanted to try to have a third child. We love our boys completely and love being parents. We wanted to add to the love in our home. Now we have been pretty fertile in the past so we knew that when we were ready to try, we had to be ready. 

I’m already a very anxious person with an anxiety disorder so the waiting game of trying to conceive and waiting to take that first pregnancy test can drive me crazy. I waited until the tests told me I could take it, which would be 6 days before my period. 

Saturday: Here we go. It’s positive! It’s a very faint line, but it’s positive! My nursing brain tells me that the HCG hormone had to have been detected for the line to show up at all. So, I’m PREGNANT! My husband needed more reassurance, but accepted it after about a half hour. I was pregnant with our third baby and I was happy. However, something didn’t feel right in my gut. 

Sunday: Let’s take another test to make sure. It’s still positive! It’s a bit darker, but still kind of faint. Something still didn’t feel right. Shouldn’t I be more excited? I’m not as happy this time as I was the other 2 times. I also wasn’t feeling as nauseous and fatigued as I had been with my previous 2 pregnancies. It was just a few small waves of nausea. I didn’t think much of it. 

Monday: I took another test. This one was darker. Ok I’ve had 3 positive pregnancy tests. Let’s do this. A part of myself was going through the motions, but another part of myself wasn’t into it. I was still feeling nausea but not a lot. I decided to tell my co-worker that I’m closest with since we she will be with me a lot during this. She was more excited than I was. What’s going on with me?

Tuesday: I’m one to tell everyone around me that I’m pregnant as soon as I found out. I often feel really sick in the beginning so people will find out anyways. I told all my co-workers by giving them donuts. Everyone was very excited. I was, in a way, forcing myself to be more excited than I was. 

Wednesday: Feeling a little more nauseous and tired today. The nausea was reassuring to me but I still felt that something was wrong. I told my husband that I thought if I got really excited that something bad would happen. Of course, he said I was crazy, or at least that what I said he was thinking. He’s smart enough to not actually say these words. 

Wednesday night: I was going to the bathroom and saw it. I saw the streak of blood. Shit. Ok, it’s normal to have a small bit of bleeding sometimes in the beginning. Although, this never happened to me before. It was too late for implantation bleeding. I told my husband, to which he said that we should wait a bit and check again. I went to the bathroom every 20 minutes. More blood every time. It kept coming. I was trying to convince myself that the color was a pink color instead of bright red. But it was red. It was a lot of blood. More than spotting. This was happening. I was having a miscarriage. I didn’t want to confirm it completely or admit it to myself. I just wanted to go to sleep and wake up from this nightmare. 

Thursday morning: More blood. I played the scenario in my head of what I now needed to do medically. I couldn’t take off my nurse hat. I was also trying to explain and console my husband of what was going to happen. I couldn’t stop thinking, “I’m so stupid. Why in the hell did I tell my co-workers? Why did I tell anyone?” I’m a very open person, but right now I didn’t want to talk to anyone about this. I went to work as usual planning to meet my midwife later to check my HCG level. I told my co-workers and didn’t want to talk further about it. I went about my work day, trying to advise other women on their health and concerns. At about 930, I had a big wave of nausea and cramping. This really hurt. This was happening. To me. I didn’t think this would happen to me. Why was God allowing this to happen? Why does he allow this to happen to any woman? This isn’t fair! I started to break down at my desk. I left work, not being able to focus on my job. I needed to process what was happening to me and I couldn’t do that at work. I went to see my midwife. She would call me later with my HCG results. 

For those of you wondering, HCG is essentially the pregnancy hormone. It’s important to check the level a few times to make sure it goes down to negative to ensure everything from the pregnancy has left the uterus. 

I spent time in the car driving and talking with a friend. My eyes hurt from all the tears. I got home and got the phone call from the nurse. My HCG level was negative. What? Negative? Already? I was advised by the nurse and the midwife that home pregnancy tests are very sensitive so I was pregnant, but the hormone level didn’t get very high, which is why it didn’t take long for it to go all the way down. Was it even enough to even call this a miscarriage? I can’t imagine what this would be like if I was farther along. I feel like that would break me. This happened so early on, but I was told that this was still a miscarriage. 

The next few days were spent still having waves of nausea, cramping and hormonal crying. Each day got a little better. It’s now two weeks later from when I found out I was pregnant. I have gotten a lot of support from friends and even found out how many more people I know that have had at least one miscarriage. I do have anxiety of this happening again, but this won’t stop us from trying add to our family. 

I now understand why women don’t want to talk about it. It hurts emotionally and physically. It’s confusing. It plays with your emotions like no other. However, I have always felt it’s important to talk about things, especially if it’s uncomfortable. The more people talk about their experiences, the more people will realize they are not alone and have more support. 

If you have never experienced a miscarriage or have ever wondered what do you even say to someone going through this, here are just a few helpful things to say, and NOT to say.

Things that are not helpful to say to someone that have had a miscarriage

·      At least you already have a child.

·      It’s ok, this happens all the time

·      You can always adopt. 

·      You can always have another

·      Your baby is an angel now. 

·      It was in God’s plan

·      At least you can get pregnant

What you should say:

·      I’m so sorry

·      What can I do to help you?

·      I’m here for you

What are your stories? What did you find helpful for support during this difficult time? Leave comments to help support others that may be going through this difficult time.

Epidurals: God's Real Gift to Women

Epidurals are the most common pain medication requested and administered during labor. Most non-healthcare people don’t really even know what an epidural is in regards to a labor patient. They call it an epidural because the medication goes into the epidural space of the spinal cord. An anesthesiologist will be the person performing the epidural and it’s done in your labor room. There’s a lot of preparation that needs to be done before this can happen so be mindful when you think you want to ask for it. If someone knows they eventually want it, I’ll start prepping before they ask for it.

A consent form needs to be signed and risks need to be talked about. This is usually difficult to understand or even care about when you’re in active labor and all you can think about is the squeezing pain of your uterus. I remember one mom who couldn’t stop moving from the pain yelling at me, “I don’t care! Just get the doctor here to give me the medicine!” And then she quickly scribbled gibberish on the form where her signature was to be signed. 

The thing that takes the longest is getting you an IV and starting IV fluids. IV fluids are given to reduce your risk of low blood pressure, which is one of the risks of an epidural. Depending on the facility, you will get about 500ml-1,000ml of before the epidural can be placed. This process can take 30-60 minutes. You also are not allowed to eat anything after getting an epidural. Depending on the facility some clear fluids are allowed. If your blood pressure does go too low then additional medication will be administered in your IV to help bring it back up.

Sitting for an epidural involves curling your body around your belly to curve your back. This helps to open space in your back to assist the doctor in placing the epidural. This can be done while lying down on your side or sitting up depending on the doctor’s preference.

While you’re waiting for the sweet relief, we will be taking your blood pressure, listening to baby’s heart, and monitoring your oxygen levels and heart rate with a probe that goes on your finger or toe. So there are a lot of things hooked up to you.

Prepping your back before the actual procedure will take a couple of minutes. They wipe down your back with antiseptic and put a drape over your back to keep things sterile. This is a sterile procedure, meaning that it’s free from bacteria and nothing that is not sterile can come in contact with it. We tell you to not put your hands behind your back or touch your shoulders, this also includes your partner that is most likely standing in front of you. 

The hardest thing about getting an epidural is when the anesthesiologist is injecting the needle and you have to stay completely still and the more you move the harder it is and the longer it takes. However, this part is usually very short and the only thing getting you through that moment is the fact that you’ll have pain relief very soon. They will put in a needle to find the right space of where to put the medication. This may take another couple of minutes. 

Once they are sure they have the needle in the right place they will insert a small flexible plastic tube and take out the needle. They will do an initial test dose all while analyzing the monitors that are spewing out all the numbers.

They will then tape the long plastic tubing to your back to ensure it stays in place. The tube is connected to a pump that will continuously pump the medication into your back to numb you from the waist down. 

Then once we get you comfortable the nurse will stay with you for a while to continue to monitor everything to make sure there are no complications.

After some time, a catheter will be inserted into your bladder to empty it. I’ve worked in places that have different policies on this. Some will use a temporary catheter and others will use a catheter that will stay in place until closer to delivery.

Now your bottom limbs have a mind of their own and that mind isn’t yours. It’s a weird feeling, like heaviness and having no control where they go. Some people have complete numbness and can’t move at all. Some people are still able to move their legs and even get into different positions. Everyone is different.

So, at this point you have the tubing from the epidural, IV tubing, monitors on your belly and finger/toe, possibly a tube for the catheter and a blood pressure cuff on your arm. This chaos of tubes and wires are a nurse’s nemesis, but we are happy that our patient is comfortable and we try to make it a functional dance.

Just a reminder, you cannot get out of bed with an epidural unless you plan to army crawl your way to delivery.

Mind Blown Moment

When the anesthesiologist puts the catheter in your spine, they are going in blindly. This means that not all epidurals are perfect. Sometimes an epidural will give complete relief from pain and other times you can still feel pain on one side, you could feel pressure but not pain, or you could have pain relief for a certain amount of time. If the epidural isn’t giving adequate relief, the anesthesiologist can give a bolus (extra dose of medication) or replace the epidural all together. 

After all the things are done, we try to get you into a comfortable position and let you rest. Since you have to lay in bed, the baby doesn’t have the movement of the pelvis that it needs to move down. So, we try to put you in different positions. We also will try to what is called a peanut ball between your legs. What did she say? A Peanut ball? Imagine an exercise ball or yoga ball that’s in the shape of a peanut. Google it. I’ll wait….Yep that’s it. Putting this between your legs helps to keep your pelvis open and wide, making a wider road for the baby to drive through. Wide Load Only Lane! 

After this we will rotate your position about every hour and you can rest in between position changes until it’s time to push. You will probably feel it when it’s time to push because you will feel the pressure of the baby’s head coming down. It’s also a possibility that you’ll feel some pain with pushing or close to pushing.TMI:I myself, felt no contractions in my uterus with my 2^ndbirth but I felt pain in my perineum (cooter, vag, va-jay-jay, hoohaa). 

After your baby is born, the epidural pump is stopped and it can take about 30 minutes to 2 hours or more for the medicine to wear off and you can walk like a human again. 

Lots of women love epidurals and wouldn’t give birth without one. Lots of women love giving birth naturally and don’t want an epidural. Neither one of these options is right or wrong. What matters is what YOU want. There’s no shame in epidurals, no matter how much you’ve told yourself that natural birth is best for you. If you suddenly decide that you don’t want to feel pain anymore and whoever decided that giving birth naturally was a good idea is insane, that’s ok. If giving birth naturally is what you want and you’ve done it with all 19 of your children, more power to you sister, seriously. 

Here’s one opinion that I will give you. This is based on my experiences as a nurse. It’s generally best to wait as long as you can tolerate it to get an epidural (but don’t wait until you’re 10cm and crowning to ask for it). Sometimes an epidural can slow down labor or make contractions less effective. Sometimes with an epidural, Pitocin is needed to make contractions stronger and closer together.  Reminder: I’m a nurse and not a doctor or midwife. Talk with your provider about risks vs benefits for your own labor and birth. 

You Say Polenta, I Say Placenta

What the heck is a placenta and why do people eat it?

The placenta is essentially the organ that connects you to the baby. It gives the baby oxygen, blood and other nutrients to grow in the uterus. The placenta is attached to the uterine wall and the umbilical cord is the pathway from the placenta to the baby. 

A big thing that most people don’t know or think about is after giving birth to your baby, you have to give birth to the placenta too! It can take up to 30 minutes for the placenta to come out and sometimes you have to push it out. For most, it’s not a big deal but some people have said that it hurts like giving birth to another baby. 

Another thing to note is that the umbilical cord can be very short or very long. They may put the baby on your stomach instead of high on your chest because it’s short. So just keep in mind to listen to the people caring for you and don’t pull the baby up higher until the cord is cut. We do this because we don’t want the cord to break on its own. 

Some people believe that consuming the placenta will help the mother somehow in postpartum, usually for the hormonal properties, decrease postpartum depression and it may give you more energy.  I’m not confirming whether these claims are true or not. There’s not a lot of research to support these claims. I don’t really believe that most of these claims are true in my own personal opinion, but you do you. I will advise you though you consult your provider before doing so. 

Some of the more popular ways the placenta is consumed is by encapsulation or eating it raw in a smoothie or drink form. Encapsulation is a process where someone who knows what they are doingdehydrates it, grinds it up, and puts the contents in gel capsules. 

Some cultures have practices where they bury the placenta. Some people like to take pictures of it. Some make art out of it by placing it on a piece of paper to paint on the tree of life. Most people want absolutely nothing to do with it all. They don’t even want to look at it. I don’t blame them. It’s pretty gross, unless you’re fascinated by such a thing like myself.