This is a collection of some of the student responses to exam 3, regarding the selection of a medical birth option to describe its use, benefits, contraindications and potential disadvantages. These are shared directly from the student perspective.
7. Choose one medicinal induction or augmentation option, and choose any of its negative side effects (at least one side effect). Explain how you would support the mother through them.
8. Choose one medicinal pain relieving option, and choose any of its negative side effects (at least one side effect). Explain how you would support the mother through them.
Extra Credit: worth one point, only for this exam:
You will learn in chapter four, many non-medical options which can serve as alternatives to medical support, and/or as supplements to medical support. Create one fictitious scenario in which a birth professional of any level might respond to a mother’s emotional needs by only presenting a medical option or a nonmedical alternative during a labor, and articulate why only providing a medical option or a nonmedical alternative in the scenario might be an insufficient approach.
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Therefore, when contractions begin, she has a very hard time relaxing (she lives in a state of hyper-arousal associated with PTSD due to the previous abuse/trauma). Even the earliest contractions result in high anxiety. She talks to herself, trying to keep her from panicking. She finds fault with herself because of her anxiety, and her sense of shame is reinforced. She says to herself, “What is wrong with me? I must be such a wimp. I was told these contractions are light, but this is horrible. I can’t do this.” The fear-tension-pain cycle is in full force. (Actually this cycle is operational at a lower level every day of her life, due to her unhealed sexual trauma.)
8.) Epidural Block; negative side effects: goal of 80% relief, not 100%, completely immobilizes patient, increased chance of needing Pitocin to speed up labor, message of pain from uterus to brain is blocked in spine, preventing brain to respond with helpful hormones to continue labor. I would softly rock mother’s pelvis to give movement as baby needs movement, massage her feet to ground her, tell her to keep contact to her baby and BE present.
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7. When a mother has her amniotic sac ruptured artificially, there is the potential that the umbilical cord may prolapse. If cord prolapse occurs, the mother should immediately be instructed to assume the open-knee chest position, with her bottom in the air and her head lowered to the ground. If this occurred in my presence, and I was the only person with the mother, I would instruct her to immediately get in the open knee chest position, then I would call 911 or buzz the nurse (if we were in the hospital). I would also coach the mother to take long deep breaths until the medical professionals arrived and took over the situation.
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Extra Credit: A mother has decided, for her first baby, to have a natural birth, at home, and has decided that she wants as little intervention as possible. Her midwife suggests that she does not need any internal exam during labour, that she will know when she needs to push, that her body will tell her. The mother labours for over 24 hours with no idea of how far dilated she is, and no idea of when the end will be. She is confused and tired, and doubting her body, worried that it has been too long and that she will not know when it is time to push. Her anxiety slows her labour, because she is scared and her fear of not knowing has gotten the best of her. Her midwife, while only trying to help by facilitating the natural, unassisted birth that the mother outlined she wanted, should have explained to her that it is ok to ask for a pelvic exam, and reassure her that sometimes it is good to know how far you have progressed. By only outlining the option of a completely unassisted birth, this has further confused the mother in to thinking that if she needs a pelvic exam to tell her when she will be ready to push, that her instincts have failed her. She may feel unsatisfied with her birth experience afterwards, and this can negatively affect her emotional well being.
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Extra Credit: The Scenario: A woman has suffered sexual abuse before and is concerned because she has heard that birthing a baby feels like being raped. The doctor recommends a c-section so she won’t have to feel those feelings. -This could be a bad thing because what the woman is afraid of is feeling out of control or violated. Depending on how she was sexually abused a c-section may remind her of those feelings too. (Having a screen keeping her from seeing her abdomen, feeling lots of pressure, not being able to move, etc.). She may experience just as much trauma from the c-section as from birthing her baby herself. It would be important to talk about how to be empowered through birth and “take control” (or take responsibility) for birthing her baby. That doesn’t mean a c-section is out of the question, it just means we need to look at the whole picture and encourage her to feel confident in her birth outcome while also feeling confident in her body and being realistic of what to expect (another words make sure she knows that a c-section may still feel somewhat like her sexual assault situation but recognizing that IT IS NOT the same experience).
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EXTRA CREDIT: I think one example of this may be a mother’s fear of having a D&C because her baby has died. As was mentioned, the mother may actually be afraid that the baby has not died and the procedure will actually be an abortion. Offering the mother the tools to see and hear that the baby has in fact died, would help her to alleviate her fears. A medical doctor may not “hear” the fear for the baby, but rather a fear of the procedure.
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7. Artificial Rupture of Mucous Membranes/Amniotomy: There is a false sense of certainty that when a mother’s water is broken, labor will automatically progress more quickly. When the amniotic sac is artificially ruptured, while it can induce active labor, that is no guarantee. Nor is it a guarantee that labor will progress quickly or effectively. So long as the baby is kept in the amniotic sac with fluid, it is kept from germs, given a protective barrier, and doesn’t run the risk for needing to be delivered within a certain time frame due to lack of fluid. If a mother I am attending to has her amniotic sac ruptured, I would work to keep her comfortable, but also help her attempt positions to get to baby to lower into the birth canal. I would keep her hydrated to maintain her energy levels, as contractions may be more painful without the amniotic fluid present. I would advocate for as few hands near perineum as possible, to lower the risk of exposure to any airborne or contact germs.
8. I’m choosing epidural block, because it is so common, and I think it’s important for me to spend extra time thinking about how I will support a mother who has an epidural. The increased chance of “needing” Pitocin to speed up labor is one I hear about often. Pitocin is so frequently called upon by medical professionals but it can make the mother’s labor so much more intense and painful than it would have been otherwise. When an epidural is given and the mom’s uterus doesn’t respond to brain signals for labor, Pitocin is given to fill that gap so to speak. Once Pitocin is administered, and the epidural is still in effect, it can still significantly slow labor. It’s kind of a vicious cycle – if Mom feels the pain from the Pitocin, she requests a higher dosage of epidural, which slows labor, which calls for an increase in Pitocin, etc. Mom can grow very tired during this time. If mom elects or agrees to an epidural, my support role would include keeping her focused so that she may be in tune with her body enough to feel or recognize contractions, encourage her to use as low a dosage on the epidural as possible for the same reasons, and watch for physical cues of side effects I could either help lessen, or assist in recovery from. If I can at all encourage Mom to avoid an epidural, with relaxation techniques, encouragement, positive reinforcement, prayer, etc. that will be my first avenue. (I’m finding a distinct pattern in pre-emptive/pro-active support rather than reactive support!)
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Extra Credit: A mother (who’s occupation is a dietician) is afraid of developing preeclampsia because she has developed it in both of her previous pregnancies. The first time it caused her to have to be painfully induced and deliver a 5 lb. baby boy 4 weeks early. The second pregnancy she ended up losing her baby girl at 33 weeks and had to deliver her stillborn. Her doctor advises her to go on a blood pressure medication and to start taking a birth control pill to avoid getting pregnant to give her body a break.I see this as an insufficient approach because her blood pressure is within normal range when she isn’t pregnant. Birth control is known to cause high blood pressure. Had her doctor also provided her with nonmedical alternatives such as eliminating artificial hormones and chemicals (such as the pill) that are more toxic to her, or referred her to a nutritionist to provide her with information regarding the Brewer Pregnancy Diet which is proven to help prevent preeclampsia, it might possibly help address her fears of endangering every child she conceives due to her history of preeclampsia. It could enlighten her on an option she may have not explored simply due to the fact that so many things she learned in school about being a “dietician” doesn’t exactly fit into the importance of what “nutrition” can solve along the way.
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