April 17, 2009

Rub-a-dub-dub

Recently, I had 2 moms use our labor tub and finally had my first tub birth. I've taken care of several women who have labored in the tub, but never delivered there. When I first started in OB, women weren't allowed to deliver in the tub, but one midwife started doing tub births and now I'm glad to say that all of the doctors are more open to this. We have a small room that houses our labor tub. There is really only room for a nurse, the doc/midwife and 1-2 support people. It is usually sniffling hot because the water is warm and again the room is small. I've found that most people either love tub deliveries or hate them. Nurses who love them like the solitude and cozy, quiet environment. Those who hate them don't like the idea of sitting in a tub with amniotic fluid, blood, mucus and feces floating around. All that happens in every delivery but it is localized in one place. We have a little scooper, basically its a net like you use in fish tanks to scoop out the poop and dispose of it. I will admit, that is one of the more interesting perks of the job. It just feels a bit odd to be fishing for turds. But I guess it doesn't bother me. One mama was a first time mom. All of her sisters, aunts and her mom all delivered very quickly without epidurals or pain medication. Once they hit 5 cm, they were delivered within an hour. A few little pushes and they delivered their baby. She thought she would be the same. She did great laboring. She walked the halls, moved around until she got to 4-5 cm then she wanted the tub. And she did go very quickly for a first time mom to fully dilated. This is where things didn't go as she planned. I don't think anyone really understands what it's like to have a baby's head trying to push it's way out of your body. I've heard it described like a hot bowling ball covered in spikes. I don't know from experience, but I can imagine that would be about right. But, she got on her hands and knees in the tub and started pushing. And pushing. And pushing. And she was very vocal. For 2 1/2 hours, she pushed. Anyway, she just wasn't budging the baby's head. Finally the midwife decided we needed to do something different. We were all afraid we would be heading back to the OR. So mom got out of the tub, and got an epidural. She kept apologizing to her family, like she had let them down. I kept reassuring her that she did a fabulous job and that she didn't have anything to apologize for. After she was comfortable, she started pushing again and this baby was just getting tired. The midwife had called her covering physician and I knew if she didn't' deliver before he got there, she would end up with a huge episiotomy and a vacuum delivery. And that's what happened. But, mom was happy she didn't end up with a c-section. I had really hoped things would go as she planned, but she was open to what needed to be done in order to have a healthy baby. She just kept wondering why she couldn't deliver as quickly as her family. One reason: they all had 6 lb babies. Her baby was over 9 lbs! All and all she was happy and said she'll try for that tub birth next time. As she was breastfeeding her baby, I overheard her ask her sister if she pooped much. Her sister said "not really, just a few little ones". And the patient said "Darn, I had hoped to go more". I have never heard anyone say that HOPED to poop! Apparently she'd been constipated for the entire pregnancy and had bowel issues all her life. So she hoped to finally have a massive BM while delivering!
Now my tub delivery was about as smooth as deliveries can go. She was a multip, and she came in at 4 cm, bag of water still intact. She entered the tub, and it really seemed like she was asleep the whole time. Her eyes were closed and she only moaned a little with each contractions. Then, she looked up and said I need to push and over 2 contractions, she delivered her baby. The midwife helped ease the baby out and towards mom and the mom reached down and really delivered the baby without much help from anyone else. It was a really nice delivery.

10 comments:

womantowomancbe said...

Pushing didn't feel that way to me at all -- it wasn't painful, except "the ring of fire" at crowning. While many women feel pain during pushing, many others do not -- myself included. For me, pushing was empowering -- finally, something to do!! Yeah, the ctx still hurt during second stage, but the actual pushing did not.

-Kathy

Jana (Varley) Green said...

Hi...I was just wondering what usually happens that makes a vacuum need to be used. My doc used one with me and I don't know why...I probably should but I don't. I did have an epesiotomy (sp). Anyway, thanks

Knitted_in_the_Womb said...

A hot bowling ball covered with spikes??? Now that is a description I've never heard.

I did have the ring of fire with my births (all 5 of them), but I never thought of a hot bowling ball...and definitely not spikes!

www.knittedinthewomb.com

Nurse Lochia said...

I will say only one patient described it that way, I just thought it was an interesting description. It was how she described her "ring of fire". And most people do feel like they are finally doing something when they start pushing. A nurse I work with said pushing felt great and that she'd push a baby out any day.
They will use a vacuum to give a little extra umpfh to mom's pushing efforts. Usually they do that if the head isn't coming down like they would like and the fetal heart rate is low. Usually though, the drop in the heart rate is a normal physiological response to head compression.

Joy said...

Very cool! I don't think I'm really into delivering that way but I think it is very beautiful!

Fertilized said...

i have watched and thought about tub/water births but think that the swiming in all that gunk would freak me out.

So I guess i am into the no way jose catagory. Great post

KELmomRN2b said...

They epi'd her after she was already 10 cm and into pushing? I've never heard of that!

Nurse Lochia said...

Only with a first baby would they try to place an epidural at 10 and pushing. The head just wasn't coming down at all. It helped her to relax her pelvis and let the baby descend.

Kes said...

I had my HBAC baby in the water and all I felt was intense pressure - I didn't even feel the "ring of fire" (I assume because I was in water).

sara said...

I'm a wimp when it comes to swimming around feces and baby goo - it's enough to make my stomach turn. And I'm a nurse! How pathetic am I, LOL? But for those who aren't as wimpy as I am...I'm glad the option is available :-)