Wednesday, July 21, 2010

Delivery by Zen

I got the page for another labor admission. “K.L. 20 y.o. G1 @ 40’0 wks in labor. 8/100/0. GBS negative. Declines epidural”. (Read: 20 year old, first pregnancy, at term, 8cm dilated.)

Now it’s not terribly uncommon for our patients to deliver without an epidural. But the ensuing delivery often entails lots of screaming, crying, and the occasional out-of-control, climbing-up-the-bed-with-a-baby-head-sticking-out episode. I knew from the moment I met this patient, she would be different.

When I walked into her labor room, I found a lovely young Southeast Asian woman, sitting on the hospital bed, eyes closed, calmly breathing through contractions. She was the quintessential picture of Zen. If she wasn’t dressed in a hospital johnny, I could’ve easily mistaken her for practicing prenatal yoga. She was almost fully dilated by the time she came up from Triage. By the looks of her, I would have thought she was 2.

As she progressed in her labor, her contractions became stronger, more difficult to breathe through. She changed positions, moaned, writhed, shook – but through it all, it was clear that she had 100% control of her labor.

In most deliveries, where the patient is numb from epidural anesthesia, a lot of labor coaching is required. The patient often can’t feel much and a good deal of time is spent teaching a woman how to push. This type of birthing is an interactive process, a team effort.

The birthing experience of this young woman, however, was completely different. Because she had no inhibition of pain or feeling, she was completely in tune with her body. She could feel when it was time to push, she could feel how and where to push, and absolutely no coaching was required. In fact, she was so much "in the zone” that anytime I spoke, I felt like I was interrupting her focus. Her process of birthing was beautiful to watch. It wasn’t that she was quiet (she was definitely making noise). It wasn’t that she was still (she was moving around a lot). It was that she was focused and in complete control with what was happening to her body. It was an empowering experience to watch.

A beautiful 5+ lb baby boy was born approximately 20 minutes into pushing. The patient did 99% of the work on her own. The one and only contribution we had was to catch the baby.

What made this patient different from the other non-anesthetized patients I’ve delivered? What was her secret? Was it her expectations? That she knew it was going to be painful and developed great coping strategies for it? Was it a personality thing? A high pain threshold?

Regardless of what her secret was, I left that delivery room inspired. Empowered. And very, very proud of my patient.

1 comment:

  1. Nice!

    And yes, I think most of it is in the expectation and attitude a pt has toward labor when they come in the door. Often it is the difference in thinking they are going to "try" to go without meds vs. having their mind (expectation) made up before they walk in the door.
    As an L&D nurse, most (not all but most) of the pts that I see having this kind of labor are new migrants who just don't really consider medication an option for them, just not done that way in their experience (when you ask if they are interested in an epidural you can tell they think it's some voodoo blood-letting, paralyzing craziness). I don't think the "success" of these labors is r/t high pain threshold.