Episode 02 - To Cope Or Not To Cope Transcript

Episode 02 of Midwives with no Lives, released on Wednesday May 17th, 2023.

Erica Lea: Hey, I'm Erica!

Ashleigh: Hi, I'm Ashleigh!

Erica Lea: And we own Cloverleaf Midwifery in Florida State. We are one licensed midwife and one student midwife. However, we're not your midwives. We seek out current and evidence based stats and information for topics we present. But this podcast should not be used as a substitute for real obstetrical or gynecological care, nor should it serve to replace the advice of your chosen provider.

Ashleigh: We do encourage you to ask hard questions and or seek out care of a provider that is a better fit for your needs. Please also note that we absolutely use filthy language during our discussions, which may occasionally be about controversial or triggering subject matter.

BOTH: So now that's out of the way, who wants to get buzzed and talk about birth shit?

Ashleigh: Today we are talking about coping with contractions.

Erica Lea: To cope or not to cope.

Ashleigh: I feel like the very first thing that I wrote down was like, what do you think a contraction feels like? How would we describe that?

Erica Lea: I've had people yell at me because sometimes I'll ask someone in a prenatal visit or on the phone, they'll call, like, in the middle of the night, and they're describing a pain. And I say, well, are you having a contraction? Do you feel like they're crampy? Like a period cramp? And they are just like I don't even know what that feels like. I've never had a period cramp before, so I think it can get a little complicated trying to describe that.

Ashleigh: I feel like you're that mean that's like, here's my deck of tricks.

Erica Lea: I have my lip balm, I have my water and my coffee. Some coffee ASMR I tried your pumpkin spice oat.

Ashleigh: What did you think? It's okay.

Erica Lea: Yeah, it's not as sweet. It's more of like the clove-y, nutmeg blend. Yeah. California Farms (I meant Califia!!).

Ashleigh: Okay. So I think that if I were going to describe contractions, I feel like early labor is like I can feel the muscle working. Like if you're lifting weights, you're like, oh, I can feel my muscles working. And then as you get through that's, when it's like crampy, like gas pain, I don't know how to explain it except more painful?

Erica Lea: They build.

Ashleigh: Yeah.

Erica Lea: And they definitely become more organized and rhythmic.

Ashleigh: So obviously, let's just start with coping with contractions. Obviously, it's easier said than done. We certainly want to provide some information that will help you along, especially if you're planning a natural birth. But they won't work for everyone. But we did find something that I think would be a great test for you. So the ice cube test on alinahealth.org, if you hold an ice cube in your hand for 1 minute, how you cope with that sensation can kind of be indicative of what might help you during labor.

Erica Lea: I love that.

Ashleigh: Yeah, like, don't talk to me, don't touch me, I just need to get through this. Or is it like I'm distracting myself? So I thought that was really interesting. I would like to see if that rings true. But the other thing that we wrote down was that this would be really helpful if you went back and listened to our last episode where we talked about physiological birth. Because then you'll know what your body is doing, the hormones that are rushing through you, and how your body really and truly is set up to have a baby.

Erica Lea: Absolutely right. Yeah. I feel like we're going to refer to that episode a lot, and then we're also going to get into each one of those hormones, like, way more in depth.

Ashleigh: Yeah, I agree. But I think it's really interesting to see how your body is there to obviously make labor happen, but then help you cope with it. It's like doing its own thing naturally. But here's what I have for coping in labor. I wrote down essential is to sleep when you can. If you can sleep through labor, do it. But then also making sure at some point in that early labor that you've fed yourself well because you never know how long you're going to be in labor.

Erica Lea: Right.

Ashleigh: And then I wrote down mindset and education. Mindset and education. Bradley, thank you. (He clearly didn't cut that out like we intended!) Obviously learn about birth, learn about the stages and phases of labor, learn about how each of those are different, how it affects your body, all of those things so that you can be well prepared. But also having the mindset that while labor is hard, that you can do it and not brushing it off of, like, well, I've seen other women have natural birth, so of course I'll be able to do it.

Erica Lea: Right.

Ashleigh: Instead acknowledging that, yes, labor is hard, but I'm strong enough to get through it. Right.

Erica Lea: It can't be stronger than you because it is you. Who's creating that labor. Right? Yes.

Ashleigh: And so in addition, with mindset, you want to release your fears and anxieties. And I would say that maybe people underestimate how much of a block those things can have on you. So really dig into anything that you're concerned about and share them so they're gone, have a cry, whatever that looks like for you. Right.

Erica Lea: I'm sorry, Ashleigh, but we have seen so many people kind of hit that block or have some other sort of factor that's preventing them from moving forward into their labor. And a good stomp and a cry is always so helpful. We've had clients make it funny.

Ashleigh: Yes.

Erica Lea: "I feel like this should just be wrapped up by now!!", or people actually literally taking a stomp outside. I think there's also something good about being outside and having those emotions released, and then there's like a shift that happens, and then they can just move forward into their labor.

Ashleigh: For sure. I feel like some of our clients have talked to us about being worried about pooping in labor and how that can hold them back from doing what needs to be done to push their baby out. So even if the thing seems inconsequential or stupid or you're embarrassed, let's just talk about it so it doesn't hold you up. The next thing I wrote down was to distract yourself. So I feel like there's a couple of different ways you could go about this, and it's probably more appropriate in early labor. But first of all, like putting on a TV show or a movie that you really like and saying like, oh, I'm just going to get through this episode. I'm just going to ignore what's happening. Music or doing things. So if you're like, I'm going to fold this basket of laundry and I'm going to ignore the feeling that I have in my body. But the last thing we wrote down are combs. So using the prickly part against your palms and kind of like squeezing so that you're giving your body a separate sensation and you're not focused on the contraction. However, we did have someone tell us that they used them so much in labor that the next day their hands were extremely sore. They couldn't grasp. So maybe save that to when you really need it. Like transition.

Erica Lea: Yeah. Where those contractions are now so powerful that you're needing something to counteract it. I remember in my labor with Everette, Bradley was sitting on the edge of the tub across from me, and I would hold against him. Like, he would pull and then I would pull. So similar to what people will hang, like a rebozo around a door frame. Right. Or someone doing hip squeezes, sacral pressure, like those kinds of things. More intense sensations to counteract the contraction that's building. And I did notice, though, when she was using those combs, while she was holding the tension purely in her hands, she was not tensing her shoulders.

Ashleigh: Yeah, that's a good point.

Erica Lea: Or like her eyebrows. I seem to remember rubbing her glabella, that space between your eyebrows, I rubbed that for her maybe like once or twice just to remind her to soften that. But for the most part, she was like, not holding tension anywhere in her body. She was putting it all in those combs.

Ashleigh: So I think that's interesting. I do think we should buy those and see how it works for some others because honestly, I feel like that's the first time I saw that.

Erica Lea: Yeah, I've been hearing about it like a new fad, so we'll have to check it out.

Ashleigh: But it seemed to work for her. So we want to pass that on to you. The next thing is that remember that you get to control your environment, mostly out of hospital. You really are in control of everything. But even in the hospital, you do have the ability to change things in a way that best suits you. So I want you to think about all of your senses. Right? So do you want it bright? Do you want it dim. How does that look to you? Do you want to put twinkly lights up; temperature so you can control the temperature in the room, but also using a heating pad or like a cold washcloth on your forehead. So there's many things that you can do in terms of getting the space in a way that feels comfortable, but also remember sounds and smells. So do you want to have candles or a diffuser, something like that? Really set yourself up for success in a way that feels most relaxing to you because the more relaxed you can be, the better you're going to be at coping through things and really allowing your body to just do what it needs to do.

Erica Lea: I think also like planning to bring your favorite pillow, definitely, and like a well traveling blanket, right? Not a quilt, obviously, but just to bring the actual smell of home and that thing that's very familiar to you, that everybody has a pillow that they need to sleep with in a certain way, right. So having that kind of brought into the hospital setting can at least allow you to connect to that thing that helps you relax.

Ashleigh: That's a good point! And then lastly for environment is do you want to put up anything that helps you? So like if you want to do words of affirmation or if there's pictures or anything that can help you kind of like focus and dial-in during a contraction, remember all of that stuff will help you focus your attention where it needs to be. So try and be mindful of what your environment is, even if you have to have a hospital birth. And then the next one we have is positions and then using water. So hydrotherapy. So Erica wrote down that we should change "q". So every five to eight contractions, and that can be many positions. So hands and knees going to the birth, ball going to the toilet sideline. There's so many different position changes you could do to really keep your labor going. And honestly, you'll find that you like some more than others. The ones you really don't like though, are probably doing the most work for you. But when you need a break, go to the positions that don't feel as intense, like take the break and then try and get back to it. And then of course, hydrotherapy. I would say that I got into the tub during transition and it was life changing while the contractions were still intense. It felt so good and so relieving to be submerged.

Erica Lea: Yeah.

Ashleigh: So I highly encourage that. And if you don't have a tub, I feel like still going into the shower. And if you have a shower head, that will still be very good for you if you put on your back or your belly, whatever feels good to you, I highly recommend doing that. And then the last thing, which is probably the most difficult is that you need to lean into those moments that really suck. So when you want to run away, like when you're like, that feels too much, like too much intensity, is when try hard to go into it. Because the only way you get to be done is to go through those sensations. And this is where I wrote down that part you had said before. Your body is making the contractions so your body is not going to hurt you. It's like when you want to pull back, know that you're safe and you're okay because it's your body doing that. But if you can lean-in, hopefully that will help shorten your labor. And so those were mine for how to cope with contractions. A couple of the other notes that Erica made were spinning babies, doing like mile's circuit and belly sifting to really help get your baby in a good position for labor. Let's see.

Erica Lea: Okay.

Ashleigh: And so she did make a note about hypnobirthing. I know we talked about this previous. I'm going to give the positive and we'll let Erica talk about the rest.

Erica Lea: I'm good for that.

Ashleigh: So she did write down that she likes that hypnobirthing will help create a muscle memory. So like getting your body to fully relax because it's something that you've practiced throughout your pregnancy. This is one element of hypnothing that she's here for. I feel like though, we really should talk about why hypnothing is not something that we really recommend to our clients.

Erica Lea: Yeah, and there's many good reasons that I don't recommend it to our clients. Some will still seek it out and I think that's fine. I think it's important that people choose a philosophy that really jives with them. Right, that is important. But the reason why I detest hypnobirthing so much is just there are these dirty and forbidden words. Right. The first and major dirty word that no one can fucking say ever is "contraction". Right. And there's nothing inherently negative about this word. It's exactly what the uterus is doing. So by referring to it as a surge or a wave doesn't really help prepare you for how truly hard these things can be. A wave is a natural, powerful occurrence. Right. And what a beautiful thing to compare contraction to. But when a muscle contracts, the smaller individual cells pull closer together to shorten the whole muscle. No where in the description of a muscle contraction does the word wave or surge appear. And they certainly don't fucking look like that when they're contracting. I fully encourage people to not buy into the negativity around this word that is perfectly describing how your uterus is functioning in labor. There's nothing wrong with that. The next dirty word is "pain". Right. So hypnobirthing tries to teach this method of childbirth that is pain-free.

Ashleigh: Yeah, I wish.

Erica Lea: And so forces this concept onto people that labor does not hurt. And this is just bullshit. Your body is going through a number of things during labor, all controlled by those beautiful hormones all controlled by those beautiful hormones we talked about last time. Contractions become very intensely powerful, long, and can be quite close together with very little breaks as your body completes the dilation process and prepares to bring baby down into the birth canal before pushing begins. This is really fucking hard work. Your body is literally using a bag of muscle to force a human baby through a bowl of bones and muscles. To think that this won't hurt or have any kind of pain right. Is absolutely setting somebody up for failure with extreme and unreal expectations. And I feel like I've seen hypnobirthing work really well for people, even first time parents. We had one not that long ago, and that actually, sometimes for some people can allow them to just not even truly pay attention to what's happening in their body or with their body. But then also, I think for those who have not developed a good foundation for how intense labor can be, it just winds up setting them up for, holy fuck, what is even happening to me? This is not okay. They told me this wasn't going to hurt.

Ashleigh: Yeah. Or be like, is something wrong? Because this does hurt. Am I doing something wrong? Because this hurts.

Erica Lea: Right.

Ashleigh: But also I feel like while I do appreciate the idea that you breathe through things and all of that stuff, I do feel like you need to be present in your body, knowing what sensations you're feeling. You know what I mean? So while I appreciate birthing in the early and active labor helping you get through those contractions, I feel like you still should try and be present in your body so you know when things are shifting and when you're feeling different sensations, like separate from contractions.

Erica Lea: Right.

Ashleigh: And I feel like in my experience, watching someone do that was almost like they totally disconnected in an attempt to breathe their baby out. So I guess I'm sure that I'll see more of it, but that would be my thing, was that it seemed like almost disconnected, which can be helpful in the beginning, but you do need to come back to yourself.

Erica Lea: Yeah. Especially with a first baby, when those muscles within the pelvic floor have never opened to allow the passage of a baby before. It's really hard work. You have to really make them open. And it takes a lot of, like, effort and concentration yeah. And a direct, connectedness, to that part of you.

Ashleigh: Agreed. Plus, I think I mean, how shitty to like, sell yourself short instead of saying, like, I'm aiming for a pain free birth. Instead of saying, like, sure, this is intense, this is painful, if that's how you want to describe it, but I'm strong enough to do that.

Erica Lea: I'm a fucking badass, and I'm doing what my body is built for.

Ashleigh: Right. So I kind of feel like you're also not giving yourself the credit that you deserve by saying, like, oh, it didn't hurt. Yes, it did. You were just about so I feel like if you can take those things into consideration, really learning about labor and delivery and what that looks like and just doing some of these things along the way, yes, contractions are hard, and yes, they can hurt. And yes, they do get super intense. But as we shared before, your body is designed to do this, and you can totally make it happen. We believe in you.

Erica Lea: Absolutely.

Ashleigh: Good word. Thank you.

Erica Lea: And so do you hear that buzzing?

Ashleigh: Do you hear that buzzing?

Erica Lea: I do. I'm not sure we're putting a pin in it for a minute. Hang on.

Ashleigh: I feel like whatever you did, made it go away.

(Thanks for cutting all that dead space out, Bradley John!!) Sorry about that folks!!

Erica Lea: All right, we'll see. So I'm going to cover what to do when you can no longer cope. And I'm going to talk about things that people will maybe feel like you're not doing your job as a midwife if someone is experiencing this shit, or that I'm not giving the credit to people who experience these things. So I just want to preface, like, I understand that's probably how a lot of this is going to come across, but unfortunately, people transfer from planned home birth scenarios a lot of the times. And this is in statistics across almost all of the midwives that I know, have worked for, have worked with at some point, like, in their statistics, transfer rates are increased for people having their first baby primip. And the reason for this is typically exhaustion.

Ashleigh: Yeah. Because they're not sleeping in early labor.

Erica Lea: Because they don't sleep in early labor. And I will say I was one of those bitches. So I did have a home birth because I was extremely dedicated to how hard labor was going to be. So I was somewhat fine. Sure. Looking back on it, looking back on it, I feel like I felt fine. Bradley, what do you think? I would love his perspective, too. Exhaustion is a really big thing. Like, contractions typically start at night because melatonin, our sleep hormone, lights up our oxytocin receptors. So we do tend to start having mild, light contractions at night. We never know if they're going to organize into real labor.

Ashleigh: Sure.

Erica Lea: But they typically do start at night. Many people report this. And so when you just fucking stay up because you think like, oh my God, I'm in labor.

Ashleigh: So excited. I'm going to time it.

Erica Lea: Yeah, if you can say that to yourself, fucking go to bed. But some people don't. And sometimes people truly are having contractions that are disrupting them. They cannot lay down. They cannot stand up. They cannot sit. They cannot find any comfortable position. And so then they just wind up not being able to sleep, at least to a restorative point. And exhaustion, at some point, our body is going through its reserves, caloric reserves. It's been mobilizing its glucose. We're burning through all of our energy and at some point we just get to a place of like, oh, nothing left to give here. So then contractions can continue to build to a particular point and they are very long and very strong and close together. But there's now no more progress happening. We've hit a wall. Malposition can also be kind of related to that can be a reason why contractions are so disruptive early on. But your uterus is attempting to not only be in labor but correct the baby's position. So it's kind of like contracting double time and they then of course. It can't just focus on the dilation part. It's like, well, I'm trying to be in labor but this baby isn't in the right spot and so it's not actually doing the appropriate work of effacing and dilating. The cervix and malposition could be a baby that's asynclytic. So if you can imagine their ear is to their shoulder. It could be like their chin is tucked but they're just facing their shoulder. Or it could be like actually their ear touching their shoulder whereas in a healthy head down position their chin is directly touching their chest. And central that's a nice well flexed position. Or they could be a malposition could also refer to them being "OP" or occiput posterior. And this is where they'd be facing up towards the pubic bone. People can run into mental blocks. Maybe they've had a previous birth trauma and they've gotten to a particular point in their labor where they maybe stalled the last time. There could be other mental blocks like maybe people going through relationship issues or having to suddenly acquire stepchildren like full time or just like other things that are now like creating a stressful environment. You could even just be having your fucking floors replaced like something could block you.

Ashleigh: Do you remember we had a client tell us that the reason that they didn't find out the gender of their baby was because they thought that they would have kind of built up a worry about having yes. Do you remember? I feel like all of those things are really important when we talk about express your fears, set yourself up for success.

Erica Lea: Yes.

Ashleigh: And even if you think that it's like something small or stupid, it's interesting because I would never have put to it, I would never have put that together. But if you are having concerns, if I know I'm having this gender, if I'm having a boy or if I'm having a girl, I might feel this way. So there was another client too that I'm thinking of that was concerned because she was having a boy but she had had some sexual trauma and that was a thing for her that was kind of like that was worrisome.

Erica Lea: Yes.

Ashleigh: So if you are in any of those situations, maybe don't find out the gender.

Erica Lea: Yeah, absolutely. No, I appreciate that. And then there can be physical attributes for dysfunctional labor. So things like different complications during pregnancy, such as like polyhydromnios, which is too much fluid, creates a very distended uterus because there's too much fluid in there. And that can prevent the uterus from contracting effectively for two reasons. So first the uterus is so distended it has trouble contracting in general but then also it may have difficulties going into labor or moving through the labor phases and stages. Because the baby is so buoyant in all of this fluid that the baby's head cannot apply directly to the cervix to then really allow the additional dilation that comes from baby applying to the cervix. A pendulous abdomen. And it has nothing to do with a maternal BMI or how tall or small a person can be. It is really just lax pelvic and abdominal tone. And so this is where the uterus actually hangs over the pubic bone. So again, that type of pendulous abdomen can cause dysfunctional labor. The uterus can't contract effectively and then cervical procedures. So LEEPs, conization techniques or ablative procedures can cause narrowing of the cervical os and interferes with cervical mucus production, which I thought was quite interesting. And those two are more likely to interfere with fertility. Not so much once you are pregnant, but of course it can. And then certainly with like, LEEP procedures, they do cause damage to the cervical structure and can actually impede its functionality. So, like, it can't dilate.

Ashleigh: Did you write down what that acronym stands for?

Erica Lea: Oh, shit. Hang on.

Ashleigh: Erica teaching us all the things.

Erica Lea: We're going to put a pin in it, babe!

Ashleigh: I feel like you were just looking at it.

Erica Lea: I know. For fucking real. Computer. So Leap stands for Loop Electrosurgical Excision Procedure. And this is where they use a wire loop heated by an electric current to remove cells and tissue within the cervix. And this is used as part of diagnostic diagnosis and treatment for abnormal cervical cells found in a PAP. They're not doing these as much anymore, or at least as frequently. Like, they have to do a lot of other things before they get to that because they realized that it was causing people to either not be able to get pregnant, impede the person's ability to stay pregnant, so it was increasing miscarriage rates or preterm labor, or if we did get to full term dysfunctional labor. Okay, really like dysfunctional labor looks like contractions that are disrupting your life. You cannot sleep, you don't want to eat, you're having difficulty finding comfort in any way.

Ashleigh: Sure.

Erica Lea: But then we're also not getting the progress that we would hope for with someone having such intense patterns like that. So what do we do at this point? We can obviously offer cervical exam to assess progress and fetal position.

Ashleigh: What do we do if someone declines cervical exam. But you're like, this seems to be going like do you just give them a long time. Are you just like, listen, we've been at this for so many hours, and what do you do if they're not consenting to that stuff?

Erica Lea: Yeah. And this is something that you recently learned in school. One of the midwives had said, like, well, you are building this relationship and this trust. You're establishing such a wonderful connection during the course of their prenatal care that hopefully when you have these conversations, they do connect to how this could be beneficial for them, that you're not just going to check them without their consent and that you're not going to recommend something to them that would be harmful to them.

Ashleigh: Right.

Erica Lea: Personally, we obviously are required to offer a cervical exam when we get to them, and I feel like I always do, but that if they are clearly in labor, I do give them a window to say, like, let's just wait a little while. We don't have to do this right now. Let's set up all of our shit. But then if we are there for an hour, maybe 2 hours, and this person is still having the same pattern as when we arrived, there's been no increase. Yeah. There's been no moving forward into the next phase, or there has been a regression of the contraction pattern. Obviously, that would be a part of the conversation. Right. Like, hey, I've just been timing your contractions. I see that they've spaced apart a little bit. How would you feel about a cervical exam at this point? Because it really can help us determine what we can do next. Like, actually oh, shit, you're 8 CM. Your baby's just trying to labor down a little bit. Let's do X, Y, and Z. Or like, oh, boy, we're 3 to 4 CM. Let's try to do a combination of magnesium and Benadryl or like a Vistaril or something like that. Try to go to sleep.

Ashleigh: Sure.

Erica Lea: And if they can't sleep and then wake up in a really rocking and rolling pattern, if there's still been no change, again, we would offer to check. And if there has been no change, then we could start talking about what a transfer would look like. But if there's something up with, like, fetal position, we can attempt to do sidelying release, mild circuit sifting, curb walking, whatever other fucking things there are out there. Flying cowgirl and Walcher's position, all of the things to try to get baby in a corrected position and down.

Ashleigh: Because it makes me think back to the labor that destroyed me. And I think to myself, if we had been at home and I feel like it would have been much sooner that we were like, hey, let's check you. Because based on what we were hearing, we were like, all right, this seems imminent. And so in that way, I just feel like establish good relationships, trust your midwives. Like, cervical exams are not the devil.

Erica Lea: Right.

Ashleigh: Anyways, I'm sorry. Go ahead.

Erica Lea: We like tangents. So of course the cervical exams can help us assess progress. Fetal possession and possession. Fetal position. Please cut that out.

Ashleigh: He sounds like someone's got like postpartum psychosis.

Erica Lea: He's not going to cut that out. (He definitely did not). Fetal position. And just kind of like help us determine where we go from here. Because right. Like, we wouldn't just transfer without knowing where we're at. Of course, this person could be almost complete. They might not be. This baby could just need a little extra time, you know, maternal stamina. So, like, how is this person coping? If they're coping just fine like I was and the baby is good, that's cool.

Ashleigh: Yeah.

Erica Lea: At some point you do start to see that once the mom is completely exhausted, if we are starting to get to a place of blood pressure being affected and stuff like that, obviously blood flow through the placenta will become compromised. The baby's tolerance of that labor could change. Like, baby could get tired after however many fucking hours and hours and hours of contractions. And there's no, like, moving forward. That baby could start to get tired too. But if mom is good and baby is good, we could just either attempt to see what we could do to allow that progress to keep going and just better establish a plan that both parties are comfortable with. Because the thing is, I'm not in the torture business, right. And I know someone who would be bad at me for saying that because I feel like they said it a lot. But people are allowed to make decisions for themselves. And if they decide, fuck this, I want to go, they should be able to go without being held hostage for the sake of a home birth. This is what you were planning.

Ashleigh: Sure.

Erica Lea: Or this is what I was planning. I don't want to transfer. Even though the benefits of transferring and having interventions could potentially increase the chances of a vaginal delivery and reduce the need for a Caesarean. Because there really is like a sweet spot if labor is not just progressing normally and normal looks different for everybody. So if labor is not progressing normally for this person, like, there is not some sort of clear progress. There is this sweet spot for introducing fluids, pitocin, to maybe organize contractions or even just get them more effective. Get them to be more effective, and of course, pain management. So the thing is, I've seen midwives keep clients at home pushing for hours and hours against a fucking cervical lip. And we're both taking turns holding this fucking cervical lip back, forcing this mom to push against that cervix for hours. I'm talking about like six, seven, 8 hours.

Ashleigh: Absolutely not.

Erica Lea: With a baby that's in a poor position, this cervix that won't budge, and this mom is now just completely depleted of everything. And this client straight up asked the midwife to transfer, and she was like, you just want to give up on your home birth like that.

Ashleigh: I mean, that's criminal.

Erica Lea: Now we have started to notice many hours into pushing, probably about an hour and a half or 2 hours before we finally did transfer this poor person, noticed a ridge across her abdomen. She was diagnosed when she got to the hospital, they did an ultrasound, quickly determined that the baby was op. She wound up getting an epidural, got some pitocin, and that baby never moved down. She never dilated past that, like nine and a half or lip. That baby never rotated, never defended. And ultimately, after several more hours, they had decided to do a cesarean and she was diagnosed with a Bandl's Ring, which is a band of constriction within the uterus. And it actually is only caused by mismanagement during the pushing phase and is what happens typically before a rupture occurs. So while she did not have a rupture, not even like a window or anything like that, but she very well could have if they had continued to push anymore, she could have potentially ruptured.

Ashleigh: I just feel like what is the when everything is said and done and you've had your baby, you should have your baby in a way that you look back and are like, that was a good experience.

Erica Lea: Absolutely.

Ashleigh: And that does not mean that you can't be in the hospital or can't.

Erica Lea: Use intervention or that a home birth can't be traumatizing as fuck. Yeah, right. So just please know that if you are planning a home birth and whether you transfer during pregnancy, there's a medical reason to transfer because it's no longer a safe place to consider delivery or you transfer while you're laboring at home. You did not fail. This is not a failed home birth attempt. This is not a failure of your body or of your baby.

Ashleigh: Right.

Erica Lea: We never know how labor is going to play out. And interventions, while they should not just be used across the board for every laboring person, have a time and a place for sure, they can be very beneficial when there are indications for them. So fluids can help with the intensities of contractions, especially if they're very close together. Fluids can just kind of help space them out because sometimes when your uterus is depleted, like your body has been depleted of like electrolytes or there's like an imbalance like that occurring, maybe you're dehydrated. Sometimes we tend to over contract and so providing fluids can even just help with the strength and the spacing. If we have transferred for the purpose of obtaining an epidural, fluids would be administered, you know, before then. And then, of course, there are IV pain meds. These are narcotics and they do cross the placenta. And all of these things. We're going to get into other episodes, but these can be helpful for people, let's say, who are wanting to put maybe their baby is like Op. They're wanting to push, but their cervix is not ready and maybe starting to swell. Maybe they're at like 8 or 9 CM, but they're very close. And clearly there has been progress to this point, but they're just maybe needing a little bit of a break and allow...

Ashleigh: Please take the edge off.

Erica Lea: Just take the edge off and allow me to not fight or push against something that I'm not ready to push against. And so it can just kind of help get a good little nap in right there at the end. Or certainly if the purpose is to obtain an epidural, you can still ask for those IV paid meds while they're administering the fluids and you're waiting for the epidural to come. And I mean, I've seen people crawling the fucking walls because they just had no idea. Or people who were experiencing like, deep transverse arrest where the baby necessarily was fine to fit through the pelvis, but whatever position they had gotten themselves into, they got wedged and could no longer descend. So in situations like that where the body really wants to get this baby out, but that baby is like those contractions are like fucking on top of one another and it's like, we just need to get you some rest and a break and maybe we can have a good nap and wake up and push baby out. Typically with deep transverse arrest or cephaloplvic disproportion, they just won't come down past a certain point or go beyond certain dilation. We'll definitely get into those and I'm putting a pin in that because I don't think they're on our topic list. Okay, so then epidural for exhaustion, stalled progress or like muscle rigidity or pelvic tension. So if you're just constantly bucking against those contractions and you're not allowing your body to do the work it's trying to do or it's just the uterus is behaving in a dysfunctional way. So it's now very difficult to cope. We have transferred people at 3 to 5 CM. They get an epidural. They have a lovely vaginal delivery after getting a really great nap. We've been with people, they have great progress up to like 9cm, typically with like, a malposition. That's just not correcting. During the labor, we get to finally pushing, but they're just exhausted. They can't find their push. They're not creating any more progress past this point. Maybe we're starting to have some fetal intolerance. We transfer in, they get an epidural. I've seen people we transfer this one person in like almost complete and she had gotten an epidural and slept for 4 hours, woke up, pushed her baby out in like 20 minutes. Whereas if we had stayed at home for that 4 hours she could have potentially wound up in a cesarean.

Ashleigh: Right? Getting an epidural is better than getting a cesarean.

Erica Lea: Absolutely.

Ashleigh: Not only that, I bet you she can look back on that labor and be like, they went the way they were supposed to. It's not this traumatic event that kind of like shadows every other birth that she had after.

Erica Lea: And we did all of the things right. Her labor started out great. She was having a fantastic labor. It was a little, I would say, like, wonky because her baby was malpositioned, but her body was doing a really great job. Her baby was just coming out OP and just hit a point where it was like, we're not going past this. We need a little extra help here. And, I mean, it was like all night. So she did just need a nap.

Ashleigh: Well, and especially if you're having intense contractions and you're like, there's like no end in sight because I'm not making progress. Like, how long am I going to do this?

Erica Lea: Right?

Ashleigh: It does seem like torture.

Erica Lea: Yeah.

Ashleigh: I just feel like a good distinction for us is that appreciating that those things are available to us and using them when appropriate. I feel like sometimes the pendulum has just swung way too far away, where now everything is terrible. We talk about the cascade of interventions and all of those things, which I do believe to be true, but that doesn't mean we just throw them all out entirely.

Erica Lea: Right.

Ashleigh: And I want to make that distinction that there are midwives out there who believe in science, us being two of them. And so you shouldn't look at all of these things similarly to hypnobirthing that they're all terrible, they're all bad for you, you should never do those things. It makes you a failure, all of that stuff, it's just not true.

Erica Lea: It's not right. And then, of course, I kind of touched on Pitocin just for disorganized contractions stalled progress. So this can obviously work on the uterus to allow contractions to be consistent and increase their strength, thereby increasing their effectiveness with dilation. Sometimes if we go in, it's because there are too many contractions happening, so typically they just get their pain management. They leave them be for a little while, and then it's like, do we need to pick up the contractions or not? At this point, sometimes people's bodies will just continue to labor, even with an epidural. An epidural is not just going to automatically stop your labor, but right, there is a time and a place for all of these things, especially if it means that staying at home is torturous to that laboring person.

And I do have some affirmations for transfers, maybe. I know we do. Here we go:

- To give up my birth plan shows great strength.

- I accept what is and trust the process. I am flexible and open to change.

- My baby chose the way they needed to be born, or my baby chooses the way they need to be born.

- Our start doesn't determine our future.

- I let go so that I can be present

- Even when I am hurting, I allow my baby to feel all of my love.

- I make this choice out of love for my baby and myself.

- I am enough. I did enough.

And...

- Trusting birth means listening to what birth is telling us, even when it's not what we want to hear.

Ashleigh: I love it. Very good, Erica.

Erica Lea: Thank you. So I guess that's it for today.

Ashleigh: I'm sure that more will come up in the future, but that's what we have for coping with contractions.

Erica Lea: Yeah. I feel like we'll also continue to delve into things in much more detail and probably come back and review things sure. From a different viewpoint.

Ashleigh: Well, I feel like once we see things we're like oh, I liked that.

Erica Lea: Yes.

Ashleigh: Plus, we definitely have more to talk about about setting yourself up in pregnancy care of yourself to help you have a good well, easy and subjective, but a good labor.

Erica Lea: Yeah, absolutely.

Ashleigh: So thanks for listening.

Erica Lea: Thank you. Bye, guys.

Ashleigh: Bye. Is it recording? Oh, shit. I'm sorry, Bradley. Okay, we live in practice in Florida State, meaning we are referencing our laws and protocols here. So if you're a midwife in another state with different or no laws or protocols, we'd really love to hear from you.

Erica Lea: If you're a midwifery client, fan, or otherwise interested in traditional midwifery care, share your questions, experiences and births to race by writing to us at midwiveswithnolives@gmail.com. Or visit us on Instagram. And until next time, may a coffee be strong and your birth be well informed. Shoutouts to my talented and frustrating husband, Bradley John, for editing our episodes ever so lovingly.

Ashleigh: And to Ashleigh Hoffman for our designing our incredible jingle.

Erica Lea: Yay. Bye.