Tuesday, September 28, 2010

See What You Can Do? (And you're not even in labor yet!!)

I have a client due now-ish, someone whom I've felt a sweet connection to from the beginning. The stakes are high for her, as she wants to have a VBAC, and she deeply questions the necessity of her c-section a few years ago.

This client, like many VBAC women, has a "supportive" OB -- who has scheduled her repeat c-section for one week past her due date. And like many VBAC women, is under a tremendous amount of pressure to go into labor spontaneously and has spent many hours fretting, losing valuable sleep as she worries about how to get labor started.

She has armed herself with tons of information, so she knows that VBAC theoretically has less inherent risks than repeat cesarean. She understands that a healthy, spontaneous labor can begin at 42 weeks, which is 2 weeks past a due date. She understands the details of her own c-section and why she is particularly low risk for possible VBAC complications. In fact, a lot of this information came from her supportive OB -- the one who scheduled her repeat c-section.

She understands that hospitals have administrative protocols, so perhaps that is the sole reason why her surgery was scheduled. When the hospital sent forms for her to sign, her OB said, "Oh, don't worry about those things!" But her due date is approaching, and the supportive OB is now saying "Hopefully we won't get to that date, so let's not worry about it now."

But she is starting to worry, because that repeat section certainly becomes more possible with each passing day.

And then yesterday she had high blood pressure. She's a pregnant woman at 39 weeks, moving triple her usual blood volume and supporting another life inside her own body. She's working hard. She's also caring for a toddler. And she's anxious about her baby's upcoming birth. Of course she's got high blood pressure.

Her OB's solution to high blood pressure is to make her not be pregnant anymore (and notice that what my client has is high blood pressure, not pre-eclampsia, and it is important to know the difference). She has swept her membranes, and wants her to return in 24 hours for another blood pressure check and for another sweeping "if this doesn't work." And then the next step would be for an induction, if her cervix is favorable. And if not, c-section.

Between now and then, I gave her a few suggestions. She has been avoiding salt, but I explained to her why the body actually needs salt and so suggested that she use a little sea salt on one small thing on her plate. I also suggested soaking in epsom salt baths, maybe 2-3 times before she returned for the blood pressure check. I also suggested that she reach out to her ever-loving network of family and friends who have offered to help her when the new baby comes and tell them she needs their help NOW, to care for her daughter, to cook up a few meals, to run some errands -- because nothing is more important right now than putting her feet up, resting, drinking lots of water, and putting to use those very same meditation and visualization exercises for labor that she's been practicing for weeks.

She returned to the OB, and guess what. Her blood pressure was down. Not only that, physically she felt better. She thanked me for the suggestions, but I told her it was her body, and that she had done it. Just wait till she's in labor.

1 comment:

Dianne said...

Great doula-ing Maria! Can't wait for the update :0)