Felicia,
I've never worked with a mom with syncope, but I do live with a child who
has a case of it that is considered very extreme. He had his first seizure
due to a syncopal episode at 9 months of age and we have dealt with it for
the last 9 years. Some of our daily living suggestions might translate to
helping a mom in labor.
Hydration is one of the biggest triggers for my son. I would suggest
emphasizing hydration long before her due date, not just during labor, just
to make sure she doesn't get into the danger zone. At our house, dehydration
and fatigue are a nasty combination.
Is this her first baby? I know that with my first child, I had no clue what
the pain would feel like and how intense it would be, despite having taken
childbirth classes. If pain is a trigger for her, as it is for most people
with syncope, being fully prepared with where she can expect pain, how it
might feel, etc. with realistic details can help her more than it can scare
her. Her pain and her fear can be a nasty combination during labor. I'd
rather see her deal with those fears ahead of time, before pain accompanies
the fears and makes a syncopal episode more likely. Along with a very
thorough explanation of the discomfort she can expect, I would do a more
thorough than usual exploration of how she might handle that discomfort in
order to help her avoid passing out.
Surely she's not planning to labor on her back with her legs in the air,
but you probably already know that that is a good solution to a syncope
episode. Once my son has begun an episode, we have two lines of defense: lie
him on his back with his legs in the air or ask him an open-ended question
to which he must respond (more than yes or no). Breath-holding is just about
the worst thing she can do so breathing patterns are even more important
than usual. Ask her what her warning signs are. If she knows it's coming
(which she probably does), ask her talking through it has ever been of help
to her in avoiding an episode. The timing on this is tricky, but if done
correctly, we've had good results. If she does end up needing to lie down in
order to avoid passing out, have a plan for getting her back up in a timely
manner if she does not want to spend the rest of her labor like that.
Does she know how low her blood pressure drops? Does she know how low her
heartrate goes during an episode? Does she know if her heart stops? Many
healthcare professionals are unaware that the heart can actually stop
briefly during an episode. In most cases it is not detectable, but if she's
hooked up to machines, someone's going to notice and might get off-track
with treating it. Does she have seizures with her episodes? I think knowing
those things about her usual patterns would be very important. Does the
sight of blood trigger an episode? If so, perhaps she doesn't need to watch
the delivery in a mirror.
I hope there's something in here that can help you and her prepare. Let me
know if I can clarify anything for you. And yes, we can deal with just about
anything better than this so I suspect her breast reduction will be more
straight forward than this.
Amy Brown, IBCLC
Colorado Springs, CO
there anyone here on the list (midwives, L&D nurses, etc) who have =
worked with a mom with vasovagal syncope with a trigger of pain - who is =
hoping for as drug free labor as possible? I (and she) would =
appreaciate any ideas, suggestions or just BTDT stories.
P.S. I feel I can handle her breast reduction easier than the syncope!
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