Why we do the things we do...
Pam asked some good questions... and I know other folks are wondering why I seem so bloody twitchy. This is the 'therapy post'.
Calm, mellow pregnant mama I am not. Despite the fact that I'd like to be. Sigh.
NST yesterday was an odd experience. Fetal non-stress-testing (for those not in the know - Dad) involves being hooked up to a monitor which traces baby's heart rate onto a pretty strip of graph paper. You are basically testing the variability in baby's heart rate over a period of time. Healthy, well oxygenated babies (with fat healthy placentas) should have spontaneous accelerations in their heart rate a certain number of times in a set amount of time. Or, they can be asleep, and they won't do that and still be perfectly fine. Non-reactive NST's can be predictive of poor outcomes. I confess that I would have to look up how often this is the case - but I'm not going to right now, because it wouldn't be good for my mental health.
After dancing AAALLLL night the night before, and then AAAALLLL the way to Tacoma in the car for the test, we got there, got hooked up to the monitor and the little bugger went to sleep. The result? Very non-sexy, not super reactive NST. Bleh. We pulled off a couple of small (barely passing) accels by poking at his bum. Very mellow cool OB, was fine with it, told me to go home, have a baby. Yeah, yeah. Working on it.
Why do an NST at 41 and 3? Normal pregnancy (again, for Dad's benefit) is considered term if baby is born anytime between 37 and 42 weeks gestation. Before 37 weeks babies are more likely to have issues with adjusting to extrauterine life (the whole breathing business in particular), and after about 42 weeks (but in some cases a lot longer) it seems as though placentas - the magical organs which sustain babies in utero - can stop functioning quite so well, and babies get less of the good stuff (nutrients, gas exchange etc.) Loads of research has indicated that more babies have more issues the further into advancing pregnancy they go. Stillbirth rates increase with advancing gestation also (the infamous dead-baby card). There are LOTS of good arguments all over the place for not FREAKING out about pregnancies which extend past 40, 41 and even 42 weeks but I'm not going to go into them here. If I wasn't the client in question I'd be a lot less twitchy right now.
Where I live (WA) state law mandates that you can't have a birth center birth if your pregnancy expends past 42 completed weeks. I'm not planning a birth center birth, so it's not a big deal. What is a big deal is that the physicians in the community (generally) prefer to induce labor at 41 weeks. It's kinda a silly reason but by having an NST at 41 and 3, if I end up going to 42 weeks, I have at least evidence of a decently healthy babe a few days ago. In short it takes their blood pressure down a bit. There are docs in the community (probably most, if not all, in my community) who will refuse to perform NST's on midwifery clients after 42 weeks, preferring to wash their hands of any liability for a post-dates pregnancy. Clients in this situation must present at the ER, and run the gauntlet of on call doc's who will press aggressively for immediate admission for induction of labor, regardless of NST or other post-dates surveillance testing results.
The other reason I wanted an NST was because I got really and truly freaked out the other night as I attempted to cough up both increadibly squashed lungs (I've mentioned this kiddo is big, right?) with a fever of almost 102 F, listening to baby's heart rate speed along at 180's and 190's (nml is between 120-160ish). I totally understood all the rational, physiological reasons why this was occurring, but it scared the crap out of me. The stupid strip was intended in part to make me feel better about consuming the fistfuls (oh, how I wish I was joking) of hepatotoxic OTC cold and flu medications for a week which I needed to control that damn fever. I'm also cognizant that if things go pearshaped at the birth and we transport that with at least that NST and OB consult under my belt I'm more likely to be able to fend off a pissed off county-call doc who's likely to take one look at my, erm, abbreviated prenatal care chart (I've been busy), all the tests I declined (for good reasons), AND the fact that I'm egregiously (by mainstream OB standards) postdates and hopefully avoid an unnecessary surgical birth. Maybe. It's more than mildly rediculous to me that I feel like I have to prepare to fight this potential battle... and yet I've seen it happen so often...
I find myself in a strangely conflicted place right now. Part of me feels well enough to hurry up and have a baby, though this brutal cough lingers and my ears feel like they might begin bleeding. I don't feel any closer to labor though. My cervix (or the portion of it that I can feel) is doing nothing worth writing home about. Babe is doing his normal morning, nap, evening squiggle and poke thing, and my uterus contracts periodically, teasing. I'll go have my membranes swept (among my least favorite sensations in the world) this afternoon, and tomorrow morning I'll down a midwives cocktail of castor oil and other goodies to see if we can't get the ball rolling.
It's startling to me though how much fear creeps in contemplating all this. I KNOW the rates at which stillbirths increase past 40 weeks. I've even bathed the still corpse of a perfect 41 weeker. I have resuscitated the babies born through thick mec, I've handled the transports for gnarly heart tones in labor, and tried my hardest to soothe the panic in the eyes of parents (while riding the indescribably unpleasant adrenaline surge) as their carefully planned gentle births, stomp out the door on gurneys born by gentle giant EMT's and go on to be born happy and healthy under hospital roofs.
And yes, those represent but a tiny handful of all the births I've attended these past few years. But they are the ones I think about today as I wait for whatever decision-maker it is who chooses when the baby comes. In the meantime I'm re-reading some Ina May, and meditating on Monkey labor.
The monkey doesn't think about birthing, she doesn't think about what might or mightn't happen. She just surrenders to the process and lets it happen.
Therein lies my challenge methinks.
I need to be a monkey for a while.
Calm, mellow pregnant mama I am not. Despite the fact that I'd like to be. Sigh.
NST yesterday was an odd experience. Fetal non-stress-testing (for those not in the know - Dad) involves being hooked up to a monitor which traces baby's heart rate onto a pretty strip of graph paper. You are basically testing the variability in baby's heart rate over a period of time. Healthy, well oxygenated babies (with fat healthy placentas) should have spontaneous accelerations in their heart rate a certain number of times in a set amount of time. Or, they can be asleep, and they won't do that and still be perfectly fine. Non-reactive NST's can be predictive of poor outcomes. I confess that I would have to look up how often this is the case - but I'm not going to right now, because it wouldn't be good for my mental health.
After dancing AAALLLL night the night before, and then AAAALLLL the way to Tacoma in the car for the test, we got there, got hooked up to the monitor and the little bugger went to sleep. The result? Very non-sexy, not super reactive NST. Bleh. We pulled off a couple of small (barely passing) accels by poking at his bum. Very mellow cool OB, was fine with it, told me to go home, have a baby. Yeah, yeah. Working on it.
Why do an NST at 41 and 3? Normal pregnancy (again, for Dad's benefit) is considered term if baby is born anytime between 37 and 42 weeks gestation. Before 37 weeks babies are more likely to have issues with adjusting to extrauterine life (the whole breathing business in particular), and after about 42 weeks (but in some cases a lot longer) it seems as though placentas - the magical organs which sustain babies in utero - can stop functioning quite so well, and babies get less of the good stuff (nutrients, gas exchange etc.) Loads of research has indicated that more babies have more issues the further into advancing pregnancy they go. Stillbirth rates increase with advancing gestation also (the infamous dead-baby card). There are LOTS of good arguments all over the place for not FREAKING out about pregnancies which extend past 40, 41 and even 42 weeks but I'm not going to go into them here. If I wasn't the client in question I'd be a lot less twitchy right now.
Where I live (WA) state law mandates that you can't have a birth center birth if your pregnancy expends past 42 completed weeks. I'm not planning a birth center birth, so it's not a big deal. What is a big deal is that the physicians in the community (generally) prefer to induce labor at 41 weeks. It's kinda a silly reason but by having an NST at 41 and 3, if I end up going to 42 weeks, I have at least evidence of a decently healthy babe a few days ago. In short it takes their blood pressure down a bit. There are docs in the community (probably most, if not all, in my community) who will refuse to perform NST's on midwifery clients after 42 weeks, preferring to wash their hands of any liability for a post-dates pregnancy. Clients in this situation must present at the ER, and run the gauntlet of on call doc's who will press aggressively for immediate admission for induction of labor, regardless of NST or other post-dates surveillance testing results.
The other reason I wanted an NST was because I got really and truly freaked out the other night as I attempted to cough up both increadibly squashed lungs (I've mentioned this kiddo is big, right?) with a fever of almost 102 F, listening to baby's heart rate speed along at 180's and 190's (nml is between 120-160ish). I totally understood all the rational, physiological reasons why this was occurring, but it scared the crap out of me. The stupid strip was intended in part to make me feel better about consuming the fistfuls (oh, how I wish I was joking) of hepatotoxic OTC cold and flu medications for a week which I needed to control that damn fever. I'm also cognizant that if things go pearshaped at the birth and we transport that with at least that NST and OB consult under my belt I'm more likely to be able to fend off a pissed off county-call doc who's likely to take one look at my, erm, abbreviated prenatal care chart (I've been busy), all the tests I declined (for good reasons), AND the fact that I'm egregiously (by mainstream OB standards) postdates and hopefully avoid an unnecessary surgical birth. Maybe. It's more than mildly rediculous to me that I feel like I have to prepare to fight this potential battle... and yet I've seen it happen so often...
I find myself in a strangely conflicted place right now. Part of me feels well enough to hurry up and have a baby, though this brutal cough lingers and my ears feel like they might begin bleeding. I don't feel any closer to labor though. My cervix (or the portion of it that I can feel) is doing nothing worth writing home about. Babe is doing his normal morning, nap, evening squiggle and poke thing, and my uterus contracts periodically, teasing. I'll go have my membranes swept (among my least favorite sensations in the world) this afternoon, and tomorrow morning I'll down a midwives cocktail of castor oil and other goodies to see if we can't get the ball rolling.
It's startling to me though how much fear creeps in contemplating all this. I KNOW the rates at which stillbirths increase past 40 weeks. I've even bathed the still corpse of a perfect 41 weeker. I have resuscitated the babies born through thick mec, I've handled the transports for gnarly heart tones in labor, and tried my hardest to soothe the panic in the eyes of parents (while riding the indescribably unpleasant adrenaline surge) as their carefully planned gentle births, stomp out the door on gurneys born by gentle giant EMT's and go on to be born happy and healthy under hospital roofs.
And yes, those represent but a tiny handful of all the births I've attended these past few years. But they are the ones I think about today as I wait for whatever decision-maker it is who chooses when the baby comes. In the meantime I'm re-reading some Ina May, and meditating on Monkey labor.
The monkey doesn't think about birthing, she doesn't think about what might or mightn't happen. She just surrenders to the process and lets it happen.
Therein lies my challenge methinks.
I need to be a monkey for a while.
posted by Louisa at 9:52 AM
2 Comments:
how you have the mindset to write all this is beyond me...but you have your head screwed on the right way and you will know what to do and when to do it. Love ~ Susie
waiting with baited breath for the story of your evening glory!
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