CHILDBIRTH CLASSES: DAY TWO

Yesterday (Sunday), was Day Two of our Childbirth Classes at St. David's Medical Center.

The agenda was:

Session #3 (Day Two - Before Lunch)
Opening Video
What to expect when you go to the hospital
-normal routines and admitting procedures
-electronic fetal monitoring, IV fluids
Labor Variations, Obstetrical Procedures and Medical Interventions
-induction and augmentation of labor
-assisted delivery
Pain Management Options
-IV Narcotics
-Epidural Analgesia
Labor Scenarios - Rehearsal and Review

Session #4 (Day Two - After Lunch)
Cesarean Birth Video and Discussion
Tour of Labor and Delivery, Nursery, and Postpartum Units
Stage 4 - Recovery (the first 2 hours) and Postpartum (the next 6 weeks)
Question and Answer
Evaluations

It was another information-filled day. My favorite part of the day was the tour. The labor & delivery rooms are so nice! As are the recovery rooms. And we got to go by the nursery and see the newborn babies. MELTED MY HEART! It just made me even more excited about meeting my little boy! :-)

After the classes, and several discussions with Mark, I have made a decision on a birth plan.

Here is a "Pain Medications Preference Scale" that we received in the classes:

+10: She wants to feel nothing: desires anesthesia before labor begins. (An impossible extreme. If she has no interest in helping herself in labor, she needs to know she will have pain, and needs reassurance. She should discuss her wishes with her caregiver.)

+9: Fear of pain; lack of confidence that she will be able to cope; dependence on staff for pain relief. (Help her accept that she will have some pain. Suggest she discuss fears with caregiver or childbirth educator. She needs information and reassurance, without false expectations.)

+7: Definite desire for anesthesia as soon in labor as the doctor will allow it, or before labor becomes painful. (Be sure the caregiver is aware of her desire for early anesthesia and that she knows the potential risks. Learn whether this is possible in your hospital. Inform staff when you arrive.)

+5: Desire for epidural anesthesia in active labor (4-5 cm); willingness to cope until then, perhaps with narcotic medication. (Encourage her in breathing and relaxation. Know comfort measure. Suggest medications to her in labor as she approaches active labor.)

+3: Desire to use some pain medication, but wants as little as possible; plans to use self-help comfort measures for part of labor. (Plan to help her keep medication use low. Use comfort measures. Help her get medications when she wants them. Suggest reduced doses of narcotics or a "light and late" epidural block.

0: No opinion or preference. This is a rare attitude among pregnant women; but not uncommon among partners or support people. (Become informed. Discuss medications. Help her decide her preferences. If she has no preference ahead of time, follow her wishes during labor.)

-3: Prefers that pain medications be avoided, but wants medication as soon as she requests it in labor. (Do not suggest that she take pain medications. Emphasize coping techniques. Do not try to talk her out of pain medications.)

-5: Strong preference to avoid pain medications, mainly for benefit to baby and labor progress. Will accept medications for difficult or long labor. (Prepare yourself for a very active role. A doula will be most helpful for both the woman and partner. Know how to help her relax and use the breathing strategies. Know the comfort measures. Do not suggest medications. If she asks, interpret it as a need for more help and try different comfort measures and more intense emotional support first. You should, however, have a prearranged plan (e.g., a "last resort" code word) for how she can let you know she really has had enough and wants medication.)

-7: Very strong desire for natural childbirth, for sense of personal gratification as well as to benefit baby and labor progress. Will be disappointed if she uses medications. (Follow the recommendations for -5, but with even greater commitment. This means planning not to use pain medications, unless complications develop that require painful procedures, or she is unable to respond to intensive labor support techniques for several contractions in a row. If she asks for medication, plan to encourage alternative comfort measures.)

-9: Wants medication to be denied by staff, even if she asks for it. (This is very difficult for the support partner - to be responsible for her satisfaction. Promise to help all you can, but help her realize the final decision is not your. It is hers.)

-10: Wants no medication, even for cesarean delivery. (An impossible extreme. Encourage her to learn of complications that require painful interventions. Help her get a realistic understanding of risks and benefits of pain medications.)

On this scale, I fall right between a -5 and -7. So, I am probably around a -6. I will accept medication if the labor is just too intense, but I don't want it offered to me. And if I ask for it, I want my support person (Mark) and the caregivers to not give it to me right away, and make sure I want it. I am definitely going to have that "last resort" code work as the back up plan. I'm not doing this naturally for personal gratification. Not even a little bit. I am doing this for the benefit of my baby and labor progress.

I am on the fence on whether or not to get a doula. I know that it would be beneficial to me, and I think it would be equally (if not more!) beneficial to Mark. He might have a tough time continuing to support me if the labor ends up being long. If I get a doula, I figure it's that much more motivation to continue a natural delivery.

So, the decision is to deliver baby Ben naturally. Now, I need to make sure I'm mentally prepared for this!