Epidural

High Risk, On Bed Rest, You Still Have Delivery Options

January 26th, 2010

Having a high risk pregnancy and being on prescribed bed rest does not mean that a woman doesn’t have delivery options. I was just reading a comment on another website from a woman who had read my post “To C or not to C That was the Question.” She shared her story of how she had had a cesarean section with her first child and then her doctor had allowed her to have a VBAC with her second child.  Her second pregnancy had been miserable and she had considered requesting a cesarean for the birth. However,  she decided to follow her doctor’s recommendation; he believed that she could deliver naturally so she did. She does not appear to have had medical complications but it was a difficult delivery that she still vividly recalls some 16 years later!

Why is it that women, especially high risk pregnant women, on bed rest or not, cede their power to their obstetricians? I am not pointing fingers here, I did the same thing myself. But I am wondering why we do it? Fear. Having a high risk pregnancy carries with it a whole host of fears and worries. Many of us who have high risk pregnancies have tried or have been trying for a long time to conceive. Many of us have lost previous pregnancies via miscarriage or stillbirths. We may have undergone assisted reproductive procedures (in vitro and others) in order to conceive. We’re here, finally, with a viable pregnancy, and now this pregnancy may be in jeopardy. In desperation, we’ll do anything. At one point during my first pregnancy I remember thinking, “I’ll  spin on my head and pull this baby out of my nose if I have to!” I was that desperate-and that afraid.

I have since learned, even if you are having a high risk pregnancy, you have options regarding your delivery. Here are 7 points to consider as you prepare for your delivery:

  • What factors make Cesarean Section Necessary? Just because your pregnancy is high risk doesn’t mean that a cesarean section is imminent. Even if you are having multiples, you don’t necessarily have to have a cesarean section. The indications or cesarean section are if the mother’s and/or baby’s life are in danger. In our culture we have moved towards “preemptive” cesarean sections to “avoid any potential complications.” Every pregnant woman needs to keep in mind that a cesarean section is major abdominal surgery and carries with it its own risks and potential complications. If you want to try to have a vaginal birth, and there are reasonable indications that this could be successful, clearly and definitively make your wishes known to your doctor and see if you can come up with a solution that will enable you to at least try vaginal delivery.
  • Will  I have to be induced? We know that the vast majority of inductions end in cesarean section. If your physician is recommending that you be induced, ask specifically why this needs to happen. I s the baby in danger? Is your health at risk? What is he/she looking to accomplish and what do they think will be the expected outcome? Having this information will allow you to communicate any fears or objections and to reach a peaceable agreement on your delivery.
  • The Epidural. An epidural is a type of anesthetic that is injected into the spinal cavity between vertebrae in the lower back to numb  you from the waist down. Some birth educators and women say that an epidural slows labor and makes it difficult to push because you can’t feel the contractions. Others say that it’s a way to be able to withstand the discomforts of labor and delivery. Whatever your decision, know your doctor’s opinion on epidurals and other pain management. Some doctors won’t have women in labor without an epidural. Others are more flexible. Also know that there is a certain time when epidurals are administered and if you progress further than that point, you may not be able to have the epidural.
  • Episiotomy. An episiotomy is a surgical cut in the perineum made my your doctor so that you won’t experience a “traumatic tear” during delivery. The necessity of episotomies is controversial. Discuss with your obstetrician their philosophy regarding episotomies and whether or not they think an episiotomy will be necessary.
  • Infant Care. This is one area where I wish I had asked more questions. While having a high risk pregnancy doesn’t automatically mean that your newborn will have complications, you may in fact have a higher likelihood of having complications and your baby requiring intensive care. I never even contemplated that there would be complications with my baby and was completely unprepared when she was whisked away to the neonatal intensive care unit (NICU). The NICU is a very intense unit and if at all possible, get some information about it before you deliver and visit. It can be a scary place, but the people who care for such little treasures are very special and are your best advocates if you need them.
  • Educate yourself. You may not be able to attend a birthing class at a hospital, but you can read information and watch videos, perfect skills for online birthing classes. Some high risk pregnant women dismiss birthing classes feeling that they won’t be able to use any of the skills. This couldn’t be further from the truth! Knowing what you may face and being able to prepare goes a long way to a smooth birth.
  • Communication is Key. A high risk pregnancy that has resulted in prolonged bed rest doesn’t mean that you don’t have options. Many obstetricians have a predetermined “protocol” as to how they manage various situations, and yet they are not averse to making changes. If there is something that you would like, make your wishes known. You may not get everything, but you’ll get more of what you want if you ask.