A Short Rant

     Braggadocio is my pet peeve in the lay-woman's pregnancy world.  Since my early feedback to this site is that I need to avoid the fancy language, I'll define what I mean, because there is a group of women to whom I am not addressing this rant.  Braggadocio is boastful talk.

     What started this rant was a page from a client of one of my colleagues, for whom I was taking call.  So I don't know this woman, and she wasn't expected to go into labor during this 4 days of coverage.  To begin with, I think they were a very innocent couple, in that they perhaps had not absorbed all the information given to them in their prenatal classes, or worse, were blinded by stories told to them and therefore did not think that this prenatal education applied to them.  This was her first baby.  Her waters had broken (SROM - spontaneous rupture of membranes) and she "was told to page right away when that happened".  The amniotic fluid was clear, the baby was moving, and she was negative for that favorite bug of ours, Group B Streptococcus.  If a woman has GBS, we give her antibiotics in labor to help protect the baby from getting infected by this bacteria.  But since she didn't have it, we had the luxury to wait until labor started.  So I instructed her about when to page back, since she clearly wasn't in labor yet.  "But," she says, "my mom delivered us all within 20 minutes of breaking her water!"  She was clearly fearful that the baby would just fall out in the next few minutes.

     Did I mention this was her first baby (primipara, or "primip")?
     "Okay, but how long was your mother in labor with her first before her water broke?".
     "Oh, I don't know.  All I know is the 20 minutes!"
So I explained to her the expectation of progress in a first time labor, the difference between early and active labor, and reinforced when to call back, which she did in about an hour and a half.  Well, it's been more than 20 minutes, I say to myself.  Her husband said that she was laboring in the tub, and that she was in a lot of pain.  Going on the theory that she comes from good breeding stock and may indeed have a very efficient primip labor, we agree to meet at the hospital.  I've seen all types of labors, and don't want to get caught with an unplanned/unattended home birth, or worse, a car birth.  I would have seen them at home, but they are anxious, and I live 30 minutes from the hospital.  Don't peek below, but try to guess now what her dilation is.

     Here, however, is the nature of my rant.  Her mother's braggadocio, and very likely lack of labor education 25-30 years ago, have prompted this woman to believe that her labor will be short and effortless.  She is not prepared.  When I see her in the hospital she is smiling between contractions,  but unhappy during them, and her cervix is 3 cm dilated.  She is very disappointed.  She says, "I guess I'm a wimp, then."  She's disappointed in herself.  She surely felt that she must be ready to deliver if she was in "so much pain", given her mother's history.  I'm sorry to have to tell her that she's not really officially in labor, but very close.  We find here using 4 cm as a definition of active labor in first-time moms allows them to get into a good labor pattern and reduces the rate of interventions that come from admitting a woman to hospital too early in labor.  She uses Nitrous Oxide (laughing gas) to get her to 5 cm dilation, which she does along the expected labor progress curve, and then asks for an epidural.  Since I have to transfer care for epidurals, the Obstetrics team takes over and I go home to sleep, since I've been up all night.  I plan to have another midwife attend the birth if the woman delivers before I've had my required sleep.  I do however, make it to the birth, 8 1/2 hours later, a very cute baby girl.  Not 20 minutes.

     The other half of this rant is the opposite problem that we see in my field.  Women who tell pregnant women their birth horror stories.  How they were in labor for days, how they "ripped from stem to stern".  I wonder what brings women to impose these terrible images on their pregnant sisters?  It is, in part, a form of braggadocio.  I'm tough because I went through this horrible experience, and lived to tell the tale.  I also believe that, in some slices of our culture, it is a form of control of the partner.  You did this to me and it was a horrible experience and I lived to tell the tale, and don't you forget it.  And finally, the group of women whom I am not addressing in this rant, those women who truly had horrible experiences, were mismanaged, misinformed, mistreated, and who now have some form of post-traumatic stress.  Don't get me wrong.  These women should still not tell their horror stories to pregnant women, but their need to talk about it is legitimate.  Their audience is not.  Talk therapy is a legitimate form of treatment for PTSD.  Pregnant women will not bring closure to the problem, skilled therapy will. 

     Having said that, a little sage advice from delivered moms can be helpful.  Pick this hospital, not that one.  Watch out for this certain caregiver, they _______.  Go to prenatal classes.  Learn what your choices are, and what are the pros and cons of these choices.  Educate yourself about, and consider a homebirth.  Oh wait a minute.  That's my advice.

Asynclitic

asynclitic (ă-sin-klit-ik) adj. a tilt of the fetal skull towards one or other shoulder causing the top of the skull to be either nearer to the sacrum or nearer to the pubis.1

In other words, a tilt of the baby's head, during labor, to the right or left of the midline. Like a dog, trying to figure you out. This is my view of the world. As in, "let's get a new angle on this".

Since I've started this blog with the definition of asynclitism, let's expound on it. Kim James, a doula, has made an excellent summary of epidural risks with links to research, or for a direct peek at research, read this.  My kudos to those practitioners and researchers who actually admit  that epidurals can increase the risk of poor positioning in labor.  Lord knows few at my hospital would admit that, but then, our epidural rate is about 80+%. Why? Well that's a rant for another day.

Why the Pelvic Outlet?

Well, this page is meant to be an outlet for my views (and very likely some frustrations will spill out here too). I was trying to play with some part of the nomenclature for the reproductive anatomy, and I couldn't make anything sacred out of sacrum, and The Mucous Blog just didn't have that kind of ring to it, you know?

So the Pelvic Outlet it is. Herein please find one person's view, one person's opinion, of pregnancy, birth and the meaning of life in modern times. Herein I hope to educate, amuse, amaze and excite, and sometimes shock if the filter between my brain and my fingers occasionally fails.

At the pelvic inlet, the diameter of the pelvis is widest from right to left.  At the pelvic outlet, the diameter is widest from front to back.  So the baby must rotate from lying sideways to turning its face towards the mother's backbone.  When the rotation is complete, the back of the baby's head is against the front of the mother's pelvis.1

Is this a metphor for life?  We could say, "in order for things to come out well, we must look backward", or "when your first view of the world is someone's anus, it's GOT to get better from there".

I had an instructor once who posited that giving birth is kind of like airplanes taking off... from a common sense standpoint, it really shouldn't happen, but it DOES!  And this is the point.  When we think about it, sitting on an egg feels like a pretty attractive way to procreate (unless you are an Antarctic penguin) when you're in the middle of transition, and it feels astounding that it happens at all, BUT IT DOES!  Yet so few women have faith in themselves and their abilities to give birth.  "I'm coming to the Labor and Delivery floor back-first, so I can have my epidural right away", I hear women say.  We have so lost touch with ourselves and our bodies, with who we are as women, that we submit ourselves to the authority of others, put ourselves and our trust into the hands of caregivers who we hope have our best interests at heart (and not just the avoidance of a lawsuit), that we lose sight of our own power in our own lives.

I became a midwife because I know that women can have amazing births.  I had amazing births, and no, I did not have a midwife.  I was guided but not pushed by my nurse and my family doc, and felt staggeringly powerful in the whole birthing process.  Now I help others to do the same.  Join me here on my weblog as I proselytize and expound on pregnancy and birth in modern times.

1.  http://labspace.open.ac.uk/mod/oucontent/view.php?id=452287&section=1.6.4