Saturday, January 17, 2015

Nitrous. Yes, No or Don't Know?

****I do not want this to become a discussion on the safety of nitrous. The evidence is strong and overwhelming on the safety; it has been used for decades with no documented concerns for women or babies. I am wanting to have a discussion about the philosophy of using something like nitrous.****

Several months ago my birth center started offering Nitrous Oxide (N2O) for the use of pain management in labor. This is something that I had been wanting to do for several years. I have been reading about it and researching it for quite some time. The first time I proposed this to the other midwives, it was not popular and was basically 'voted' down. A year or so passed, we had some changes in midwives and I presented the idea again. This time the response was very positive and we decided to go for it. I then did all the necessary things; staff training and education, ordering the equipment, letting our families know complete with educational handouts and consent forms, and all the other technical requirements. And in September of 2014 we rolled it out.

Prior to this, I had never seen N2O used. I was simply passionate about it as a safe option for women. As a midwife, I am committed to ensuring that women have options and are presented those options with true informed consent. I spoke with several people; other midwives, experts in the field and women and felt that it should be an option. At the time there was no other facility in our entire state offering N2O. Since then, one of our local hospitals has started offering it as well. I am very happy about that as it only increases access and choice to the women of my community.

Now that we have been using it, I have several observations from experience. There are things that I really like about it and others that I don't. Overall though I really like this option and am very glad that we have it available. I know for a fact that it has helped to prevent several transfers from our center to the hospital and that is a huge success to me. We have also used it to prevent a transfer postpartum for a laceration repair in a woman with severe anxiety about the process. Here is a little break down of my thoughts so far;

Things That I Like
  • The woman is in complete control.
  • It can be used in the birth pool, sitting on the birth ball, in the bathroom on the toilet, standing at the get the point.
  • It can become a sort of focal point that helps her to focus on her breathing.
  • It really seems to decrease anxiety
  • It can be used at anytime during labor
  • It can be used for other indications; laceration repair, third stage, IUD insertions
  • If she does not like it for any reason, she simply stops using it and the effects wear off within minutes
Things That I Don't Like
  • The machine is cumbersome and takes up a good amount of space
  • The scavenging vacuum is loud, it becomes a 'white' noise but is still there
  • The mask can seem claustrophobic
  • It can be distracting for some women to figure out the timing, making it harder to focus on her breathing
Clearly, N2O is not for everyone and sometimes it just does not offer any benefit for an individual woman. It does not take the pain away and so the expectations have to be appropriate. What I have noticed in the social media forums is that there is a definite bias in some of the "natural childbirth" communities against N2O. Bias that using N2O is not "natural birth". That it is a type of cop out or that only women who don't have good enough midwives, support persons or who are not properly prepared would need it. To me, this smacks of judgment, which is something I think that we all as humans need to be very careful of. Judgment runs rampant in our current birth culture and this is just another example of that. So, what do you think? Have you used N2O yourself or have you had clients use it? I would love a positive, open discussion about all thoughts.

Thursday, January 1, 2015

Elemental My Dear

This work, the work of being With Woman, is elemental.

Conception is a spark, bright and warm, in the watery depths of the Mother. A spark fed by the eternal breath of the Creator.

The baby grows and develops in the dark, rich soil of the womb fed by the running waters of the Mother's blood.

Labor is a force of nature! It requires the passion of fire, the gentleness of water, the calm of air and the strength of earth. And let's not forget the Spirit, ever present and supporting.

As a midwife, the element that I most often channel is that of water. I am never exactly the same midwife for every woman. I am always myself (guided by Spirit) and bring with me my fundamental knowledge (supported by the Earth), have passion and compassion for my families and the work (fueled by Fire) and my critical thinking skills (through the lens of Air). However, it is as water that I enter each birth space. Each woman has her own song, her own path and will need me to adjust to her. Water takes the shape of the space it fills and that is how I enter; filling the space as needed. Water is soft, gently supporting and caressing, warm or cool depending on the need. Water is strong, clearing away obstacles and creating new paths. Water is quiet, whispering in your ear. Water is
booming, commanding attention when necessary. Water is my midwife elemental energy.

Midwives and Doulas out there...what is your birth element and why?....