Monday, December 6, 2010
Obstetric Lie #100- Failure To Progress
(Do you think I will be able to come up with 100 lies in obstetrics? I do.)
Failure to progress. Oft named as a reason for cesarean. Oft mentioned to the supine mom in the hospital as she is encouraged to get her epidural and "relax". By the naysayers in the natural birth community, it is often renamed, Failure to be Patient or just, Doc must leave to make his golf game.
Whatever it means to you, the term failure to progress is both powerful, disturbing, and strongly indicates not just lack of ability but complete and utter physical failure on the part of the mother. Personally, I would love to see this phrase just disappear from our culture all together.
And so, in an effort to trash this phrase for once and for all, lets take a closer look at it.
The Vaginal Exam
Ahh yes, you can not actually talk about the term "failure to progress" without first discussing the vaginal exam. Though the VE can give you plenty of useful information, it can not in fact tell you when you are going to actually HAVE YOUR BABY.
If you learn nothing today, learn this: Nobody will know how you are progressing, if nobody puts their hands in your vagina. If you don't want to be diagnosed as a failure, simply remove the test that does the diagnosing.
You do not need a vaginal exam to have a baby. I am serious. They will still come out.
So, one first step to eliminating the term, "failure to progress" is to eliminate the routine vaginal exam. The truth is, a woman can be dilated to a five for a month and have her baby at 40 weeks. A woman can also be dilated to a five and have her baby 10 minutes later. The body does not listen to textbooks. Especially textbooks that say you must dilate one centimeter an hour once you hit active labor. Like a baby, your body has no idea how it should act in order to ensure a textbook medical labor. Leave it alone.
The truth is this- science can not totally understand, quantify or write books about birth. You can take all measurable things and put them together and still not KNOW when a woman should have her baby.
Can we understand birth? On an instinctual and female level, yes. On a scientific level, no. Birth is not science. It involves head, emotions, body, place, fear, expectation, and much more.
Now lets assume you are getting vaginal exams and your body does "stick" or "fail" at a certain point of dilation.
What Happens During Birth?
As a birthing woman I believe there is much more going on here than simple measurements. A woman who is stuck at a six for hours on end is not a failure. Is the baby healthy? Is mother healthy? If the answer is yes to these questions then plenty could be happening that we can't see or feel.
You are taking a huge step into an unknown realm. I think this is part of the reason why the first labor is often the longest. It is not just the first time our body is doing this, it is the first time our brain and our spirit are doing this too. (Even if it not your first child, it is still the first time you are birthing THIS child.)
Maybe you fear something. Maybe you have to let go of something. Maybe you have to say goodbye to something. What could this "something" be? Closing a chapter and opening a new one on your relationship with your lover. Letting go of fears about becoming a mother. Letting go of fear and hurt and abuse and worry. Letting go of or working through past birth trauma. You are not failing, you are learning.
But birth is not just emotional either. It is also physical. Things can be happening in the body that we can't see either. Bones and ligaments are moving and stretching. The baby is being massaged as he comes down the birth canal. Your body is preparing colostrum for that first feeding. The baby is turning and finding his best way out. Your body should be moving with him and helping him. Being strapped down and getting medicated or cut open is not necessarily the answer. You are not failing, you are preparing.
Patience, Young Skywalker
If it takes time to become a Jedi, then I think it is safe to say that it takes time to become a mother. Why don't most babies just fly out? Your body births with all the accompanying signs and feelings and sensations in order to prepare you for motherhood. Motherhood is a big deal. It takes time to prepare for it. Let it take its time.
Stay where you feel comfortable laboring as long as you need too. If you get to your birth place and you are not very dilated and not showing signs of very active labor, go home. Don't feel like a failure about it. It is OK. You are excited to be on the journey.
Studies have shown that c-section rates are high in part to simple lack of patience. Talk to your care provider. Ask questions. "How long can I be in active labor before you start to worry?" "Can I avoid vaginal exams?" "If mom and baby are fine, can I labor as long as I would like?"
So how do you avoid failure to progress?
First, don't assume that the vaginal exam will tell you if you are progressing. If that is how we measure the pass/fail in childbirth, then I for one am scared to take that test. (It is always a bad sign when the person handing out the grades puts on a glove and asks you to spread your legs.)
Second, don't assume that staying in a certain spot dilation wise indicates failure. There is a lot we don't understand about birth. And there is a lot more to birth than what we can measure.
Then, be patient yourself. It isn't just up to your doctor to trust birth. It is up to YOU. Let your baby come when it is ready. An induced, undercooked baby may simply not want to come out yet. They can get it out. But not the way it normally comes. Let your labor start on its own, and then let it proceed on its own.
Stay mobile. Your body wants to move that baby down and out. Be logical. What positions assist that and what positions work against that?
Lastly, be aware of your own emotions and fears. What are they? What can you do about them? Could they effect your labor? Are you willing to face them and deal with them?
Oh wait- I forgot one! Don't get an epidural! Sometimes they cause no problem. But many a woman has had trouble with failure only AFTER the administration of drug that numbs half your body. Who would have thought?
Do some women have to have their babies via c-section? Of course. But your body is not a failure and it is not broken. It works. I am willing to bet that not only is your body perfectly capable of opening and having a baby, it is more capable of doing that than 100% of the male Ob's out there.
(Because of course, they don't even have vagina's.)