Thursday, September 25, 2008
On April 29th, 7 days past my due date, Barbara came to my house for a pre-natal. We talked about doing things to work on getting the baby out, but nothing drastic. Baby was posterior at this point, and I was concerned about starting things before he or she was in a good position. I really didn’t want to be too aggressive. It suddenly dawned on us that we have an acupuncturist in our office! I had no problem having some acupuncture done at all. We called Evelyn and set up an appointment for the next morning and if things didn’t start, we would do it again in the late afternoon. That night, Darren and I went to dinner with Barbara and Sarah at Fleming’s. It was a wonderful evening, great food and great company. We had such a good time, joking with our server about my water breaking there in the restaurant.
We went to bed around 11:30 Sunday night, and like 6 out of 8 of my previous labors, I woke up to contractions in the middle of the night, at 2:16am. These were of a different quality than the ones on Friday night, but I didn’t want to get too excited. They were anywhere from 8-15 minutes apart, some lasting 1 minute or more, some only a few seconds. I was able to ignore them for the most part, and slept off and on until about 7:30am. I got up, ate breakfast, told Darren it might be the start of something, then called Barbara and cancelled my appointment with Evelyn. I puttered around the house, Darren filled the AquaDoula, and most of the kids stayed home from school. (They were all given the choice of staying or going to school. Talyn was the only one who chose to go.)
During this time, beginning at around 2am, one of our cats became my guardian. When I woke up in the middle of the night, he was sleeping on my pillow. He was by my side the entire labor, while I was at home. He followed me from room to room. When I went into the bathroom, he sat outside the door, meowing and stretching his paw under the door. He did not want to let me out of his sight.
Around 11am or so, things slowed down a lot. I figured it probably had to do with baby still being posterior. I was doing a lot of hands and knees and kneeling forward on pillows, my bed and my ball during this time, trying to encourage the baby to turn. I wasn’t worried, I just figured he or she would turn eventually. I had no back pain at all, which I was very happy for. I tried to keep busy, and organized all of my yarn, which I had saved for a labor project. It did keep me busy!
Around 2 or 3pm, it seemed as though everything came to a complete stop. I decided I needed to get out of the house. I don’t remember if it was hot or cold outside, but I remember telling Darren I wanted to go walk around at an indoor mall. The closest one to us is about 30 minutes away by freeway, and we were getting into rush hour. We were a little unsure about driving in it, especially if contractions picked up while we were out. We definitely did not want to get stuck in traffic. We decided to go to an outdoor mall much closer to home.
We got to the mall, and walked around a bit. Within about 30 minutes, I started having contractions again, and they were more intense than before, although still about 15 minutes apart. We went into a few stores, then sat down on a bench. Contractions had started getting a little more regular, closer and more intense, but still manageable. I was still able to walk and talk through them. We decided to go to dinner and then go home.
While we were eating dinner, contractions got a lot more intense. At one point, I had one that was so strong, I shoved the table away from me and into Darren’s stomach! We left shortly after that, and got home around 6 or 6:30pm.
Contractions continued, and I spent a lot of time in my bedroom. I was still kneeling forward a lot, trying to get baby to turn anterior. Darren asked me several times if I wanted to get into the pool, but I had checked myself, and knew I was only about 3cm. I didn’t want to get into the pool and have everything slow down. I continued laboring in my room, walking around the house for a few more hours.
This labor felt different than my others, and I can only assume it was because of the baby’s position. I never had any back pain, or really any pain at all. It just felt different, intense. I would check my cervix, and I could tell the head was not anterior. I found out by accident that standing up actually felt very good during a contraction! I decided to finally get into the pool, I think it was right at 10pm. I called Barbara right before that, maybe 10 minutes, and told her it would be a good time to come and do pictures. I really felt that I still had hours to go, and that I would probably have the baby by the morning.
Once I got into the pool, the intensity reduced by a tremendous amount. A few minutes after I got in the pool, I checked myself again and I was about 5cm. Darren was in the pool, and I would lean on him during a contraction. It was really good, and felt so much better than being on land. Things were picking up, and Darren said a few times that my labors always moved fast once I got into the water. It usually did, but I wasn’t thinking about previous labors at that point. Barbara arrived, set up some stuff and started taking pictures. I STILL thought it would be hours before the baby came.
Within minutes of Barbara’s arrival, my water broke (10:20pm). At that time, I am sure the baby turned anterior. Suddenly, things felt different, better! I checked myself, and I felt like I was almost completely dilated, with just a bit of a lip in front. I thought, “That can’t be right! I was just about 5cm a few minutes ago.”
With the next contraction, my body pushed. I was taken by surprise. For some reason, I didn’t feel ready to push. I said a few times “My body’s pushing, I’m not doing it.” I still felt a cervical lip, but it was shrinking with each contraction/push. Somewhere, a part of me worried about it being the cord and not a lip, and I asked Barb if she wanted to check it. She said no, that I was fine.
The baby’s head was really low, but I didn’t realize how close to birth it was. My brain had not caught up with my body, and I wasn’t in the place of mentally being ready to birth this baby. It went faster than I thought it would. With the next contraction, the baby was almost crowning, but not quite. One more contraction, and the head started coming, and I realized that this was it and I would be holding our new baby very soon. This is usually my hardest point in labor, I am usually very scared and I tend to freak out. But this time I didn’t, and I am so proud of that fact. It was intense, but I only felt a little bit of burning. I kept my hand on the baby’s head, and slowly it crowned, then was out. Well, mostly out. It actually came out slower than any other birth I have had. I had to push a little more to get the head all the way out.
There was a slight lull, then another contraction came. I pushed, but the baby didn’t budge. I felt the head, and thought it rotated, but it actually hadn’t. I tried changing position, and lunging my leg to the side, and still baby wasn’t coming. I knew it was a shoulder dystocia. I said something to Barbara, although I don’t remember what I said exactly, but I think I told her I needed help.
She told me to stand up and put my leg on the side of the pool, so I did. She asked if she could reach in, and I said yes. At this point, we knew the baby’s head hadn’t rotated. Barbara tried to get the baby out, but it was not budging in the least. She told me to get out of the tub, and get on the floor. I knew from another shoulder dystocia birth what she wanted me to do, so I got on the floor, and pulled my legs back into McRobert’s position. I started freaking out a little bit then, and it hurt like hell. The assistant, and friend of mine, D., arrived right as the baby’s head came out. Now she was on my left side, holding my leg back, but I was fighting against her. Barbara got the shoulders out, then the rest of the body, and she put the baby on my stomach.
As the baby came out, we heard a little sound, and thought everything was okay. But once he/she was on my chest, there was no response. I was rubbing, and trying to stimulate him/her, but there was nothing. Barbara asked for oxygen, and told me she was going to use it. I said okay. But when I saw her put the mask on my baby’s face, I thought it was over and that the baby was going to die. I almost lost it, I was never so scared in any of my other births. 10 puffs of oxygen in 15 seconds, and finally baby started breathing. The relief I felt was incredible, overwhelming. I found out later that there was also had a nuchal cord, and it was very tight. The cord was white and limp by the time the baby was born.
I stayed there for a few minutes, and then I needed to get up. I wasn’t very comfortable, and I needed to be able to get a good look at my baby. I wasn’t bleeding more than normal, which was a good thing. I asked Barbara if I tore, and she just said she didn’t know. I didn’t think I did, but with a shoulder dystocia like that, I would not have been surprised.
I got onto the couch, and after a little while, I started feeling lots of cramps. Some were horrendous. I knew the placenta had to come out, and I tried pushing a few times, but it hadn’t completely separated yet. I also knew from previous experience that it was starting to separate, and that the pain would stop once it was out. I was really uncomfortable, and I had to hand the baby to Darren a few times to hold, because the pressure was just too much on my stomach.
Finally, I felt something give, and I was able to push/pull the placenta out. (Looking at my chart later, the placenta was delivered at 11:38pm) Barb brought a bowl over, and I put it in. There was a HUGE clot, almost the size of a liver. And this was one big placenta. We weighed it later, it was 2 pounds. It was really cool to completely deliver my placenta by myself. Kyra looked a bit bruised to me, so I asked Barbara about giving her a vitamin K shot, which I didn’t do with any of my other homeborn babies. I really felt it was appropriate this time. Barbara asked if I wanted to give it to her, but no…..I was the client this time, not the apprentice.
I don’t remember how long we waited, but I decided it was time to find out what kind of baby we had. I looked under the towel, and saw we had another girl! (In looking at my chart later, it was 16 minutes) Darren was right, he said it would be a girl. She had a ton of hair too, which is blonde. She started nursing after a short time, and didn’t need much instruction. We sat in the family room, next to the pool for a while, then we went to our bedroom. We weighed her, and I was shocked when she tipped the scale at 10lb 7oz. I never thought she would be THAT big. I did her newborn exam, including measuring her head, which was a good 15”. Also another surprise to me, so I had to take a picture of the measuring tape around her head. Her chest was 16”, and according to my back-up midwife, this would classify her as macrosomic. Eh, I don’t care much, because she is here and healthy.
I went to the bathroom, and was 99% sure that I had not torn. By the second time I went to the bathroom, I was 100% sure. Not even a skid mark. No more bleeding than is normal. I used a frozen pad, just because I had them. There was some normal swelling, and the cold pad really did feel good, even without any tearing.
So, this birth was not quite as romantic as Landen’s. Barbara apologized for having to step in and catch my baby. But I have no regrets, no unfulfilled wishes, no feelings of disappointment AT ALL. I have told her not to apologize anymore. Yes, we wanted to catch our baby, and have everything go smoothly and beautifully, without a hitch at all. But what we wanted much more than that was a live baby, and a live mother. And we got those. Barbara did EXACTLY what I had her there for. She was here as our lifeguard. Would Darren and I have gotten Kyra out eventually? Possibly, probably. But I feel much better knowing that I followed MY instinct, my “feeling”, my “knowing” while I was pregnant. I feel that I protected myself and my baby exactly the way I needed to. I am grateful that Barbara was there, that I could trust her to only do what was necessary, what I asked her to do. If you read Landen’s story, you will know that I did ask for her help in his birth, but she knew I didn’t need her to take over, and she didn’t even touch me. For Kyra’s birth, I needed her to take a more active role, and she did just that. Once we were both stable, maybe 5 minutes, Barbara again stepped back and just observed. Exactly what I needed. I do feel that Kyra’s birth went perfectly, and exactly as it was meant to.
One last tidbit, and then you can read the post script if you choose…..One of my back-up midwives practiced for a while in Guatemala, where they did not wear gloves to attend births. At a pre-natal appointment, she asked me if I ever caught a baby without gloves. No, I never have, I have actually only caught one baby. Barbara mentioned that in all these years, she has caught one baby without gloves. She had to pull down a woman’s pants because the baby was actually already born, but mom’s pants were still on, and there was no time for gloves. Well, Barbara had been taking pictures of me laboring, and when it came time to help get Kyra out, she had no time to put on gloves. Neither one of us realized it until days later.
****As a sort of postscript, there is another part of all this that I need to include. It may sound odd to some, but most will get it and understand what I am saying. There are times, lately related to the births I have been going to, when I “know” things. It is hard to explain….I don’t see visions, really, but I have a sense of knowing, and sometimes there is a bit of “seeing”. I can sometimes envision a scene, but it isn’t specific or clear, more like a feeling.
We had a birth in December, in which I was going to catch the baby. It was going to be my first catch. Neither mom nor dad had any desire to be the one to catch. Barbara asked me often if I was excited, nervous. I said I was excited, but that the birth wasn’t about me, or my first catch, it was about the mom and her baby. I really felt that something was going to happen at the birth and that someone else would catch the baby, and I assumed it would be Barbara. I also mentioned a few times that I couldn’t see this mom giving birth. Usually I can imagine what it would be like. But this time, I just couldn’t visualize a picture in my head. As it turned out, I didn’t catch this baby because we missed the birth completely. I believe that is why I couldn’t “see” this mom giving birth, because I wasn’t meant to be there.
Our next birth was in February. This mom always had her babies very, very fast. Barbara often felt that we wouldn’t make it to her birth, but I felt very confident that we would be there. I often “saw” myself on the floor, next to the mom on her left side, and she was laying on the floor. There had been no discussion about me catching, I think the plan was for mom and/or dad to catch, although I can’t remember specific conversations. As this birth turned out, I got there before Barbara, and mom had the baby only minutes after I walked in the door. It was my first catch, as mom wasn’t in a position to catch herself. And after baby was born, and things started to settle down a bit, there I was, sitting next to mom, on the floor, on her left side.
So, I give this background to explain this part. Way back in the beginning of my pregnancy, I had a feeling, a knowing, that “something” was going to happen. I felt it was important that Barbara be there. I didn’t know what was going to happen, but I was scared of whatever it was. I tried very hard during my pregnancy to be positive, to not give into fear, to visualize a perfect, peaceful birth, much like #8 had been. Darren was going to catch our baby, and everything would go smoothly. But always, there was this feeling. During my pregnancy, my iron levels were very low, and I almost missed out on a homebirth, and I though “Is this the “thing”?” So, when my labor started and stopped and baby was still posterior, I thought “Is this the “thing”?” Then, when I felt the cervical lip, a thought went through my head that it was the cord, and I though “Is this the “thing”?” And when she was stuck, and I had to get out of the tub, I thought “Oh, this MUST be the “thing”!” But then I saw her on my stomach, not breathing, not responding, and Barbara breathing for her with oxygen, I thought “Oh please, DON’T LET THIS BE THE “THING”!!!” And thank goodness, it wasn’t.
When I was pregnant with Landen, I really wanted a UC. I had Barbara there because I trusted that she would respect my wishes and sit on the other side of the room until/unless we needed her. And she did exactly that. This time, I just knew that Barbara HAD to be there. I am very glad that she was.
I do wish every woman could have the same kind of gentle, respectful birth attendant. Some women want much more hands on, some need and want more guidance, and some want something completely different. I am forever grateful that I have Barbara as my mentor, my midwife and my friend. I am learning how to be the kind of midwife I feel is every woman’s right.
Wednesday, August 15, 2007
This first picture, however, demonstrates what occurred when mom was admitted to the hospital. The baby's baseline fetal heart tones were about 100, albeit somewhat reactive. FHTs during the pregnancy were 140's-150's, so 100's were somewhat disconcerting. Dr. Wonderful was called in.
This photo shows mom's sister laying on hands and giving loving energy. Mom is talking to the baby, letting her know she is safe and all is well... dad, as we can see, is concerned, but hanging in there. Mom has oxygen on her and technology all around.
The (wonderful, amazing) nurse (we had) did a vaginal exam and found mom to be 3 cm. The nurse and I began preparing mom for a cesarean - physically and emotionally. I explained the cesarean procedure, the epidural... and the nurse said the anesthesiologist would do a spinal because the spinal would be faster... and I explained things to dad, tried to get his garb for him to put on, but we were busy getting consents signed and all. Waiting for the doctor seemed endless. Fetal heart tones were dipping into the 90's and not getting any higher than 110 with accelerations. I kept calm, but was clear and sharp with the information.
My dear doctor was on the phone at the nurse's station when I went out to go ask his ETA and our nurse said, "Do you want to talk to him?" and I emphatically said, "YES!" before the other nurse hung up and said he was on his way in.
Dr. Wonderful floated into the room like a silk scarf on perfumed air, filled with more confidence and hope than I carried - more like a midwife than I was at that moment.
He did a vaginal exam and immediately, the baby's heart rate jumped to 148! She loved his touch on her head. Oh, and how I did, too. Mom had also progressed to 6 cm. in the last 30 minutes. Amazing!
Tears fell from my eyes as I watched the baby's heart rate settle back down into the low 100's (90's/100's) and the doctor suggested taking a whiff of oxygen every few minutes when she felt like it instead of keeping it on all the time like she had been. He also told her she didn't have to lie on her left side... to move wherever she wanted to - oh, how she wanted to be on her hands and knees! He said the baby was just low, having a vagal response and there was no need for a cesarean at all.
And me, thinking he needed a scalpel. How precipitous I would have been as a surgeon! Thank the goddess it wasn't me making that decision.
The entire labor, my client was extremely vocal, so much so that at one point, the people next door banged on the wall, presumedly to make her be quiet. She, so high in her Laborland (her word), made passing notice, "What's that?" - not, "Oh, am I too loud?" I was so friggin' amused, I joined her howls, getting even louder than her for a few contractions lest she be worried at all about the sounds (she wasn't). No nurse came in to tell her/us to be quiet - that she was scaring the other women or that she was using all her energy in the wrong way or anything. She just howled her baby on down. Yummy!
And so mom moves onto her hands and knees... squats at times, rocks at times... even once jumped up onto her haunches from hands and knees!
I love, Love, LOVE this photo. It speaks of the beauty a hospital birth can actually attain when given a chance with the right doctors, nurses and hospital. And supportive midwife as doula.
Because we thought she would need a cesarean, we had mom take off her gorgeous Hawaiian dress and mom was then naked. The great nurse handed mom a hospital gown once mom knew she was going to stay laboring in that room and she promptly took the gown, put it in front of her and puked all over it. I thought I was going to pee in my pants from laughing so hard. No one ever offered her another gown.
Dr. Wonderful and Nurse Fantastic are seen below with mom as she feels her baby's head as it descends into her vagina. The doctor is on her left side, on the bed; the nurse, kneeling on the floor. Most of the time, I was where the nurse was, but occassionally moved to take photos. Notice that mom's belts have been removed... this is easily many, many minutes before the birth. We/I held the monitor to her belly instead of her having to contend with the strap at the end. I held the monitor on her belly for most of labor so she was able to move around, too. I much prefer hand cramps to a mom's immobilization.
Mom had a couple of exams. The nurse asked to do an exam when mom had an urge to push, but I discouraged it, so she went away. When mom thought she was pushing, I asked her to feel for herself and she felt for the head and it was, indeed there. I couldn't see (my head was down under her, lying on the bed), so Dr. Wonderful just rested his hand on her perineum for one second and said, "Yup, baby's right there," and removed his hand.
I was inches away from mom's perineum as the baby was coming towards the earth and this was the last photo right before Dr. Wonderful put his hands in the way and covered the head as the baby was being born. (I'm going to have to speak to him about that!) This series of minute forward motion head shots is so incredible because I can see the capillaries stretching/breaking in mom's vulva as the head descends. Who knew all that happened!
Dad wasn't sure about catching, was going to help me catch when we were having a homebirth, but wasn't so sure about it at the hospital. Once there, though, I'd talked him into helping the doc and even had him practice washing his hands with the fancy foot soap and water thingie at the sink. Once the doctor was there, though, he was more nervous, but as things got closer, I put my midwife voice on and said, "You will only birth this child ONE TIME, so I HIGHLY suggest..." and that was as far as I needed to go before he jumped up and washed his hands and got ready to help the doc catch his baby.
The picture below is the beautiful photo of dad (who does NOT have gloves on, thank goodness!) assisting Dr. Wonderful with his newborn daughter.
In 24 years and 8 months of assisting women in birth in the hospital, I have never seen a woman birth on hands and knees. I've never seen an OB or a CNM allow a woman to birth in the hands and knees position. I have never seen an OB do a vaginal exam on a woman in any position except on her back until this birth when this doctor did a vaginal exam with mom on her hands and knees. I actually wondered if he could even find her vagina with her on her hands and knees! He didn't have any problems at all. Shocking. I think I've seen a CNM do a vaginal exam on a woman in an "alternative" position maybe 20 times in all these years, so even that is a sad commentary. I tell women I can find their vagina or fetal heart tones if they are hanging from chandeliers! How did I get so good at it? PRACTICE!
Nothing needs to be said about a mother's love. This picture is my desktop right now. I think this is one of the best pictures I have ever done showing a mother and child. I get shivers just looking at it! The shadows are perfect, the lights... the IV... all of it... her daughter isn't even 3 minutes old in this picture.
I end the series with a tender surprise photo I took of Dr. Wonderful with my client. He embraced her, then she him. He with tears in his eyes and both of them whispering thanks to each other.
So, it just seemed so important to demonstrate how it CAN be. It might not be for anyone else in the world but this one mom - or the moms who get this one amazing doctor - but if this one man can exist, then there is hope in hospital birth. It doesn't mean hospital birth replaces homebirth at all. My client needed to birth in the hospital for a very serious reason and she was so amazingly gracious about moving to the hospital to deliver there. So, if some women do have to deliver in the hospital... isn't it a good thing to have hope?
Monday, June 25, 2007
Mom did have a successful VBAC - 10 hours after her AROM with about an hour of pushing. She was told she would never be able to push out any sized child, yet pushed out an Occiput Posterior baby without any bony damage to either herself or her baby. Imagine that! Don't you love when women prove OBs wrong?!
Saturday, January 20, 2007
In September, I was the midwife at the birth of a 23-year old black woman and her 24-year old black husband, both of whom are veterans of the Gulf War. The labor was rather long and I was assisted by my apprentice (who is white) and my assistant (who is black) and the dad's mom was also there. The other person there was a Home Health Nurse (HHN), a white woman who was about 58 years old, that the mother had gotten to know during the pregnancy. When mom (I'll call her Mary) wanted to invite the HHN, we had a session of exploring why she wanted her there and Mary said she was a sort of surrogate mom and she really wanted to show her what a home birth was like. In the first part of the discussions, that was the true reason that had come out... that she'd seen hospital births, but the prospect of being able to see a homebirth was fascinating to her.
At the home visit, we let the HHN know that birth wasn't just walking in and the baby dropping out. She nodded her understanding, but she still looked at us with a glazed semi-smiling look on her face.
When Mary was in labor, the HHN was bored shitless. Originally bounding in at 3am, by 20 hours later, she wanted to go home and wasn't shy about letting us know with her body language. She had gone home at one point to sleep, but when things picked up, we called her back as she'd asked us to. (Oh, if we could only go back.)
During labor, we laughed a lot. Mom spent time in the tub, wandered around the apartment and we listened to a lot of different types of music. One of the most amusing and memorable parts of the earlier labor came when dad put Sade on the cd player. I learned the pronunciation of the artist was "Shar-day" and when I, who was extremely tired anyway, said I knew every word of that particular cd and loved "Shar-day" so much, it set off howls of laughter from the black folk in the apartment. My apprentice and I, baffled by the cackles, didn't understand until they explained the pronunciation was actually "Shah-day."
An entire separation of cultures began, lovingly and humorously, as, over and over, differences were pointed out or given friendly winks and any word that could be twisted around, was to cause gales of laughter. One of the funniest was when mom got out of the tub and I got some Shea Butter to rub all over her very dry skin. Almost in unison, the black folk in the room said, "You mean the 'Sharrrrrrr' butter?"
Interestingly, once labor got really tough, mom coped really well with my assistant, so she spent most of the time doing the support. Having done labor support with several different cultures, I have often seen the most welcome support come from someone of the same culture and/or language. I was not of this mother's culture and my assistant was.
Mary started pushing and she really didn't like it one bit. Loud, raucous and wiggling, mom fought ever contraction and we, her support team, stroked, loved, cajoled, teased, directed, ordered, laughed, barked, whispered, waited, sat quietly, and offered her whatever we could as the head showed itself with a palm-sized amount presenting at the vagina. Thank goodness, the heart tones were holding their own during this one hour plus experience, but we didn't know how much longer that was going to be the case.
Mary screamed over and over that she was done. She was not going to do it anymore, to just pull the baby out. No amount of explaining could convince her the baby wasn't coming without her help and finally she exhausted herself and her body stiffened, her eyes rolled back in her head and she began to faint. To the uninitiated on-looker, it would probably look like the beginnings of a seizure, and surely could have been, but she shuddered slightly and when we took her blood pressure immediately, it was absolutely normal, her pulse fine and she was merely unresponsive verbally.
The HHN had her fingers on her cell phone and had already dialed 9-1 and I looked at her and said, "Call 9-1-1" and she hit the last 1 of the number, stepped out and within 2 minutes, two police officers were in the room. A few minutes after that, EMS was there and mom was a little more responsive.
All vitals remained normal as I explained the situation to the paramedics. We could still see the same palm-sized amount of head when she had a contraction and the EMTs were delighted that they might get to see a homebirth. Everybody was very respectful with each other and as the mom said she did want to stay home and birth there, the EMTs asked if they could stay and watch. Mom said, "sure" and the guys hung out and cheered behind me. I had to stop them from hollering at her to push (maybe I shouldn't have!) and they remained excited to possibly see the baby born. I explained things quietly, so they knew what was going on and the discussion in-between contractions was quiet and respectful between the Captain and myself. At least one of the young guys hadn't ever seen a baby born before and a couple of them hadn't seen a homebirth. He was giddy with excitement.
Then Mary started screaming again and no amount of trying to calm her down was working. In front of the EMTs and the HHN, the screaming wasn't going to go over very long so the EMTs asked if she wanted to go to the hospital and she cried, "Yes!" When I asked her what the hospital was going to do, she cried, "They will take it out!" I tried to explain that she would still have to push and I don't think she heard me as she began a mantra of "No, no, no, no..." and the EMTs brought the gurney into the room that had been sitting in the living room waiting the whole time.
If none of these people had not been there, we would have put mom in the car and gone to the hospital by my office. Instead, she was taken to the hospital the ambulance took her to.
There's this thing with midwives and EMTs around here. When we did In-Services, we asked about going in the back of the "rigs" with our clients and some of the guys said they would never let us in and some said it depended on the situation, but they all said to never ask... that they would pick who got to go. So, even though I had made it distinctly clear in speech and actions that I was the Licensed Midwife and Mary's husband was right behind her the whole time, the EMT in charge pointed to and said to my assistant, "Do you want to go?"
In a 5-minute conversation that lasted 20 seconds with our eyes (and just our eyes), the assistant and I looked at each other and said:
She: May I go?
Me: It'll be a great learning opportunity.
She: Shouldn't you go?
Me: But they asked you.
She: But maybe if you asked to go.
Me: Then no one will be with her; they'll get mad and she'll be alone.
She: I want to go.
Me: Then go!
She: I'll go!
And off she goes in the ambulance with my client. Dad and grandma follow behind in the car. My apprentice and I, having 2 other women post-dates, have to put the birth kit back together exactly correctly, but it doesn't take more than a few minutes and then we dash to the hospital ourselves.
What I learned later is that in the ambulance, the EMTs were terrified Mary was going to deliver and kept asking the assistant to look under the sheet to see if the baby was there. Praying the baby would be there each time she looked, it wasn't and the assistant had to tell the guys it was fine, the baby wasn't there yet. Mom was screaming with contractions and it sounded like she was pushing, but the baby wasn't progressing past the same place as before.
When one EMT tried to take mom's BP during a contraction, the assistant suggested they might want to wait until a contraction was over. When he was able to do so, he merely obtained the systolic and the person writing on the chart said, "That's enough for me!" It was certainly an odd ride.
Getting to the hospital, they were taken to L&D and the EMTs pointed to the assistant and said, "She can tell you what happened," and gave vitals before leaving. My assistant explained the labor's beginning, rupture of membranes, vitals throughout labor and mom's decision not to continue pushing at home - hence the decision to transport to the hospital.
Instead of continuing in narrative form, I diverge into a more official capacity. Follow along if you will.
Below, you will find the letter I wrote as the official complaint sent to JCAHO (pronounced jay-coh) - the Joint Commission on Accreditation of Healthcare Organizations - an organization that hospitals voluntarily join because it looks so great on their records since JCAHO supposedly is an outside organization providing an objective view of a hospital's performance in a variety of areas. From JCAHO's website:
Joint Commission evaluates the quality and safety of care for nearly 15,000 health care organizations. To maintain and earn accreditation, organizations must have an extensive on-site review by a team of Joint Commission health care professionals, at least once every three years. The purpose of the review is to evaluate the organization's performance in areas that affect your care. Accreditation may then be awarded based on how well the organizations met Joint Commission standards.
Coincidentally, within 2 months after I wrote my letter, the hospital in question had their review. This gets confusing, so please follow the bouncing bureaucratic ball.
First, about The Letter.
I was implored (by the Powers That Be That Shall Remain Nameless) to keep as much emotion out of it as possible. I had to write about 10 versions before I got to this sterilized version. No words can explain the amount of anger I felt during the recovery with this mother and trying to help her while having no one hear any of us screaming for help. I chose to use the mother's first name in the letter (not here, the name used is not her real name - anything in italics has been changed, not to protect anyone, but just because at this point) because I felt it would make a much more personal impact... that she was a real person and not just some "patient," but a woman with a baby and a husband and a life. I chose each word very carefully. It took me about 3 weeks to complete the letter.
So, here is the sterilized version and I will continue below the letter after that.
October 11, 2006
To All It May Concern:
I am writing to notify you of a serious breach of care in That Hospital on September 11, 2006 between the hours of 2:00pm and approximately 6:00pm. Because this is a long and convoluted story filled with emotion, I will attempt to bullet point where the neglect occurred with the hospital staff and try to curb the intense amount of anger and disgust I feel towards those that interacted with and were supposed to care for my client Mary Morris and her newborn baby. Having attended well over 500 births in hospitals around the United States and Germany, I am well aware of the standards of care for a maternity patient and a newborn. I have also attended births in eight other hospitals here in Our County so understand the standard of care for this county in particular. What I experienced at That Hospital was anything but the normal standard of care.
• During the birth, I was, apparently, being summoned by Dr. Colon (quite loudly and angrily according to my client and my assistant), yet I was forbidden from entering the labor and delivery suite. I identified myself to the nurse at the front desk twice as Mary Morris' Licensed Midwife and she summarily dismissed me saying, “No visitors. Sit over there,” and pointed to the waiting room. I was permitted to enter approximately twelve minutes postpartum and never saw Dr. Colon.
• Dr. Colon stood against the far wall with his arms crossed as the baby was being born forcing the nurse to do the delivery. No explanation was given for this behavior. While I did not witness this, my assistant, the baby’s father and grandmother did witness this happening.
• Dr. Colon approached the delivery bed after the birth of the baby to pull the placenta out, causing excruciating pain for Mary. She still, many weeks later, remembers the pain in detail.
• Dr. Colon, while raising the bed, stated that he was sure Mary tore (in her vagina), but upon inspection, stated surprisingly there wasn’t anything but a skidmark (a common term for a slight abrasion). He then stated that he was going to suture it anyway and sutured her perineum without any Lidocaine or medication of any kind. Mary did not have an epidural. He placed one stitch in the lower left inner vagina. While the records state it was a first degree tear, his words in the delivery room stated otherwise. In 24 years, I have never seen even one suture placed without anesthesia.
• Dr. Colon never introduced himself to Mary, never addressed Mary, never asked permission to touch her nor even congratulated her for the birth of her son. He merely pulled her placenta out, sutured her without medication and then threw the gloves in the garbage and walked out of the room.
• No vitals were ever done by your staff on Mary during the time I was in the room which was approximately 3.5 hours.
• No one on your staff checked Mary’s fundus or her blood loss during the time I was in the room.
• The baby never went to the warmer.
• The baby never received Erythromycin eye ointment despite the parent’s desire for it. The hospital never offered to place the ointment within the first two hours of the baby’s birth despite it being the law. The parents ultimately signed a release that I would give the ointment at home, which I did, but they had not been offered it within the legal time frame.
• The baby did not receive a Vitamin K shot despite the parent’s desire for it. The hospital never offered to give the injection despite it being the law to give it very shortly after the baby’s birth. The parents ultimately signed a release that I would give the injection at home, which I did, but they had not been offered it within the legal time frame.
• The baby had his temperature checked twice – once at birth (which I did not witness) and once again about three hours postpartum. This is not the correct standard of care for a newborn.
• The baby had his heart and lungs listened to twice – once at birth (which I did not witness) and once again about three hours postpartum. This is not the correct standard of care for a newborn.
• The baby did not have his identification band placed on his ankle. After obtaining Mary’s medical records, it states in the records, “parents refused placement” which is incorrect since no one ever tried or came near with a band. The mother is a Licensed Practical Nurse and absolutely knows the vast importance of security in a hospital, especially of a newborn baby and would never have refused such an important detail.
• The parents were not told the baby’s birth time and only learned it when they went to fill out the birth certificate four days later. We had to piece it together via cell phone logs and were two minutes off for those four days. No one considered it important enough to tell the family the baby’s birth time, something that is a normal course of events in a typical hospital birth.
• The baby was given one hat. When asked for another hat, we were refused and told another would be given on the postpartum floor.
• The baby was given one blanket and it was wet from the birth and the baby had also had a bowel movement at the birth (meconium), so the blanket was covered in that, too. When we asked for another blanket, that request was ignored. We cleaned the baby with a chux pad as best as we could and used the sheet Mary was wrapped in (bloody and wet from the birth) to keep the baby warm until we found a blanket in the isolette tucked under a chux pad. We’d searched the room for a towel, washcloth, sheet, gown – anything – and there was nothing. I’d used my skirt at one point, too, to keep the baby warm. Once we found the blanket, we used that until my apprentice and the grandmother went home and got the baby some clothes.
• The baby was weighed only after the parent’s requested it several times.
• Mary was never given a gown.
• Mary was given one pad to wear during the entire time in her bed. The only time she was offered another pad was when we were leaving and the nurse brought a postpartum pack in and set it down by the sink in the room, not helping Mary, who was in the bathroom, in any way.
• Mary was not offered a frozen pad as women typically are after a vaginal birth.
• Mary’s sheets were never changed. She never received a blanket change despite our asking for something that wasn’t bloody and wet.
• Mary and her husband wanted to leave the hospital with the lack of care they were receiving, but I explicitly told them I felt it was important to at least stay the night and make a decision in the morning. And then the next event occurred that ruined any chance of their consideration of staying in That Hospital.
• A woman who never identified herself entered the room yelling and proceeded to demand Mary’s chart from me. I identified myself and explained that HIPAA regulations forbade my being able to give the chart directly to her, but I was glad to share the information with the mother’s permission. She became increasingly agitated and her voice escalated and the father and grandmother all began yelling together. At a birth! My best guess was the woman was the Charge Nurse since she, at one point shouted, “I’m in charge here!” She had a Caribbean accent (the baby’s grandmother was from the Caribbean so recognized it easily). The woman stated she needed information from the chart and for me to give her the chart immediately and I once again said I could not and said I had the lab information and flow sheet of her prenatals I was glad to share with her and if the mother signed a records release I was glad to copy the chart for her. The mother shook her head no and the woman left the room very angry.
• As she left, Mary said she would crawl out of your hospital before being subjected to the lack of care she was receiving by staying in. I could no longer disagree with her decision to leave.
• A woman entered the room and said she was a neonatologist, but she never stated her name. She said she was there to examine the baby. The parents said they did not want an exam and that was when the doctor left the room and left the door completely open with the mother naked on the bed and the curtain open. Those in the hallway stood staring inside the room until we realized the doctor was not returning and my assistant went to close the door. At no time did the doctor state risks of leaving Against Medical Advice or any concerns she had regarding the baby’s birth as has occurred with other clients who have opted out of routine hospital procedures in any other hospital over the last 20+ years in my experience.
• When Mary went to the bathroom for the first time, no nurse accompanied her.
• No final vitals were done on either Mary or the baby before leaving the maternity floor. This is in direct conflict with standards of care in my experience.
• When we left the maternity floor to leave, no nurse checked to make sure Mary had the right baby – in fact, no acknowledgement was made whatsoever of her presence and that she was leaving the floor with a newborn baby. No nurse accompanied her from the room to the elevator, from the elevator to the ground floor or from the inside to the outside of the hospital. She left the hospital unattended completely. No nurse was there in case she was bleeding or felt faint.
• When the baby was put in the car seat in the car, no nurse checked to make sure the baby was put in the car seat correctly.
• When we arrived home fifteen minutes later, the Local City Police were blocking the family’s garage and said the hospital asked that they come and check on the baby’s health and well-being. We were quite surprised considering how little That Hospital seemed to care when we were IN the hospital. They asked for proof that I was a Licensed Midwife, which I showed them immediately and they quickly left. I am not sure why Dr. Colon, the Charge Nurse or any number of others at That Hospital did not ask me for my identification while we were still at the hospital instead of sending the police to hinder the safety of the mother and baby; I would have complied happily.
• Child Protective Services was called on the family and came to visit on day two postpartum as well as have a lengthy phone call with me regarding the Morris’ parenting style and choice to leave That Hospital Against Medical Advice. She also stated there were issues with meconium staining the hospital mentioned. No one at the hospital had mentioned the concerns the day before. Her quick assessment that That Hospital’s accusations were “unfounded” speaks volumes regarding the lengths That Hospital went to discredit a perfectly respectable young married couple.
As a Licensed Midwife in Our County, I understand circumstances might not always be the most comfortable for me when I have a transfer or a transport to a local hospital. However, never have I seen a client punished in the way Mary Morris was punished for wanting a homebirth. And she transferred without any complications! I shudder to think how she would have been treated had she come with a life-threatening complication. It is beyond comprehension how human beings can treat a birthing woman and a newborn baby with such disdain and cruelty. There is no excuse for this type of behavior in a hospital in any city in America. For God’s sake, I recently returned from working in a hospital in New Orleans and their care was so tender and so loving - Hurricane Katrina had changed their emotional lives so dramatically that those nurses and doctors have found renewed spirituality in their care-giving skills. Does That Hospital need a disaster to re-awaken to human kindness? I pray not.
I will continue to work diligently in my profession to maintain the utmost in integrity. If any doctor, nurse, board member or staff member has any questions, please do not hesitate to call and ask me to answer it for them.
My Name, Licensed Midwife, Certified Professional Midwife
Ph# My Number Email: My Email
So, I know it sounds unbelievable. If I read it, I would blink and have a hard time believing it, too. My apprentice and the assistant for that birth will look at each other all these months later and still shake our heads wondering if what we saw was real. It was.
It was so real, the hospital staff had to lie about it all.
When JCAHO was in town, we discovered we had an ally in the hospital. That person (whom we will call The Mole) became our inside information about the JCAHO hearings going on and tried to help us get into the hearings so our side could be heard.
You see, this is the interesting part about the JCAHO hearings, they are public, but unannounced. Well, The Mole let us know when they were, but the segments where the public can speak is minimal and specifically scheduled - and UNscheduled - if that makes any sense at all. (It probably does in bureaucracy world.) So, the parents and I called the JCAHO and hospital people in charge of the hearings asking to speak and we were told, over and over, that the hearings were unscheduled for the public. At one point I asked if I just needed to come down and sit 24 hours a day because I would. It was then that, of course, the public hearings were completed, so it wouldn't be necessary to come at all.
So, JCAHO never heard our version of the story beyond what I wrote and what the family wrote and an extensive interview done by some government man who didn't understand birth one iota.
JCAHO did, however, get to hear the entire story from each of the players involved on the hospital's side. Weren't they lucky? seething even now
The doctor, the head nurse (yes she was the head nurse), the "nice nurse" (whom I will speak about later), the bitch nurse, the neonatologist and every bit player involved got to have a say. And did they ever have their say.
The nurses said the mom was so out of control and so crazy, they couldn't get near her to give her a gown or to take the baby to put him in the warmer. BLESSEDLY, we have pictures (thank the Universe for my apprentice taking pictures!!!) of mom serenely holding her baby and the "nice nurse" holding the baby at one point on the way to the baby scale - gee, 3.5 hours postpartum, the baby still had meconium where we couldn't wipe it off of him... wonder why that was. Anyway, the nurses said we were SO mean and SO snotty to them that THEY CRIED at the nurses station!!!!!!!!!!!!!!!! They could hardly wait until we left because we were so mean. They'd hardly met any group of people so horrible. blinking in utter disbelief
If they cried, and I hope they did, it was from the amazing realization of the cruelty to another human being that they inflicted - TWO human beings. I hope they are crying right this minute.
Mary and her husband came to the hospital with a camcorder. When Mary was in the bathroom before she was leaving, I was in there with her as was her husband. My apprentice and assistant were getting the baby dressed on the bed. The "nice nurse" came in, gave us a "going home pack" by setting it on the sink in the room... not giving it to us in the bathroom (where we could have used it since it had pads in it) - and she walked out without saying a word. I had to walk out to the sink to go get a pad for mom.
It was days before we realized the camcorder, which had been sitting at that sink, was gone. The "nice nurse" had surely been instructed to kindly remove it from the room lest there be evidence on it. I am sure she is crying the most. She tried to be nice, but it was obvious she was told to give only the most cursory of un-care and words to us.How did this end with JCAHO?
The hospital received a brand new Gold Seal of Approval! None of the nurses, nor the doctor were disciplined for their horrific behavior, BUT, the one thing that was found was the doctor had not explained the risks and benefits of lidocaine to the mother before suturing her (he claimed she refused the lidocaine). The hospital was fined a delightfully hefty fine from what I hear, but other than that, my mom is left out of any anything.
- No one to listen to her side of the story that would be able to do anything to the doctors or nurses directly.
- No lawyer will take her case because she can't show permanent damage to her or the baby (apparently fear of sex and the excruciating pain of being sutured without pain meds isn't worthy of a lawsuit - not to mention utter neglect in a hospital) .
- No restitution for her bills, pain and suffering or therapy she has needed to work through this experience.
HOWEVER, a New Mole has come out of the hospital steering mom into a new direction that might lead to a better sounding board than JCAHO. We'll see if it works out.
So, dear readers, you who know me can understand why I was so traumatized in September when this birth occurred.
Although I couldn't say it in the letter, in the investigation, we did state that race and socioeconomic status had a very big part in Mary's care. It was apparent they thought she was a single black woman coming in with her sister, when, in fact, the woman who accompanied her in the ambulance, was my assistant (who happened to be black). My client was having a hard time keeping control initially, but my assistant was able to calm her periodically and once the mom realized she was going to have to push the baby out in the hospital without assistance, she began to push in earnest and the baby was born within a few contractions.
(This brings me to the interesting concept we espouse about babies coming out even without a mom's active pushing. Apparently, this mom fought so hard against the baby, she maintained a location of homeostasis as far as where the baby remained in the vagina. The uterus, during the entire 90 minute pushing/un-pushing production remained extremely active and we could see the baby's head presenting more at the entroitus, but the baby receded each time the contraction ended. The thought that something might be holding the baby up crossed our minds, except there were none of the tell-tale signs of decelerations that would occur with a short cord or a nuchal cord. The whole thing was so odd.)
Immediately upon arrival, a nurse said to mom, "We're not nice like those homebirth midwives. We're gonna get that baby out." This was the Bitch Nurse. She continued being snotty and curt with Mary and was rough with her body and then with the baby as he was born. My assistant has an amazing capacity for recollection and I am thrilled she was allowed into the ambulance so she could make meticulous notes of every single thing that unfolded while I couldn't be there.
The doctor did, indeed, stand in the corner of the room yelling about me, asking where I was, why wasn't I there, that he knew there really was no midwife, that I had just ABANDONED my client and what kind of midwife is that. The whole time, the nurse is asking him to come to the table because the birth is imminent and he stood in the corner of the room with his arms crossed, not budging, in his street clothes. The nurse "delivered" the baby and the doctor strode to mom, shoved the nurse aside, put gloves on, yanked the cord so hard mom screamed until she nearly fainted, pulled the cord out, shoved his fist so hard down on her abdomen she had tears streaming from her eyes and then raised the bed to look at her while commenting that he knew she tore. Surprised, he said she just had a skid mark, but he was going to stitch it anyway. He grabbed the suture, placed the stitch while my mom screamed to the heavens and then he took his gloves off, threw them on the floor and turned and walked out the door.
That entire time, I was in the lobby trying to get in and was not allowed in. The nurse placed a faux call to the room and turned back to me and said, "No visitors," and pointed to the waiting room and told me to sit down and wait. I called my assistant's cell phone, but she didn't answer. Brilliantly, my apprentice called the hospital and asked to be put through to the patient's room. My assistant answered and she told me the baby had just been born (this is the way we pieced together the incorrect time of birth until we saw the hospital birth certificate work sheet 4 days later) and that mom needed her, she had to go. This was right when the doctor walked up to the table to yank the cord out and the assault began. It's too bad we weren't on a cell phone to be able to tape it.
12 minutes after the answering of the phone call, dad came out and brought us into the room. I walked right past the doctor, but he didn't say a word to me; I didn't know he was her doctor or I would have said something. Nobody ever asked me who I was, but I introduced myself each time a nurse came in, even the screaming nurse. Incredibly, I remained professional and civil (perhaps I should have gone berserk and run around the hospital floor screaming my disgust at their behavior? they would have kicked me out, surely.) and was very proud of my behavior with the staff.
I believe I would have been more demanding of "things" next time. Even though we asked for things like towels and gowns and washcloths and blankets and were turned down each time, something in me thinks I could have been more aggressive. I look at myself and wonder what I could have done to not have my client be punished in this way and in my heart of hearts know they were treating her this way because they just have an evil place in their heads for people of poverty.
When mom's husband came in during the delivery, he was shell-shocked, so didn't speak until after the birth and once he started speaking, the nurses started taking notice... the couple is extremely well-educated and don't "sound black" (according to how our society would consider blacks to sound). It threw the nurses off. And what was even more shocking to them was when, 3 hours into the horror, the insurance chick came in and snottily said, "I suppose you don't have insurance either, do you." Dad said, "As a matter of fact, we have Famous Great PPO Insurance," and the insurance chick about swallowed her tongue, threw the papers at them and rushed out of the room embarrassed as hell.
Having mom sign the papers to leave was our biggest mistake. Mom just wanted to get out of there and she didn't look at anything she was signing and signed too many things that ended up saying she didn't want this (Vitamin K) or that (Erythromycin). If you all are ever in a similar chaotic situation, do not EVER sign anything without reading it first - even if you can't wait to get OUT of there. It isn't worth it in the end. And, for the record, it isn't any of those papers that are keeping a lawyer from taking her case. The papers are the least of it in the grand scheme of it all legally, but because they are a legal document, in these investigations, they meant a lot. And it sucked to give them anything at all.
I am exhausted from writing this for 2 days and I know I could continue writing for 3 more because the 5 of us have picked this apart ad infinitum - we have considered and re-considered every nuance of this case. I have played and re-played every detail over and over, asking myself what I would have done differently.
You might wonder, what happened to the HHN? When the ambulance took mom out of the apartment, she left and didn't call for 5 days. She was "tired." The mom is very sorry she ever invited her to the birth and very much feels she had a hand in the demise of her homebirth, or at least, a peaceful birth in a location that would have treated her with respect and dignity.
Mom will have a homebirth next time. She says she will never be afraid of that pain of pushing again. She will find strength in that experience and not be afraid of most things in her life that are seemingly unbearable challenges. She has found enormous strength in her birth experience. Her husband loves her and while he was extremely sad to not have the homebirth he wanted so badly, he has supported and protected her in this healing in ways many men would never have known how to do. His words, his deeds, his tenderness and love ooze from his heart and cover his family in a way I don't see coming from most 40-year olds, much less someone of his young age. I am honored to know them both.
The assistant and apprentice have found healing easier than I (or so it seems to me) and they continue loving me through my pain. Is it always so different for the midwife herself? I want to erase the experience. I wish I could turn back time and find the magic words to make her push that baby out in her bedroom. I wish I never knew there were nurses and doctors who were so evil and cruel in my own city. I wish I still believed people could never be so evil to a birthing mother and a newborn baby. I wish I had never been witness to such horror. I feel like my illusion of hospital care has been raped... and my illusion wasn't even all that glamorous! I hate that I might have to go back to that hospital and have to find a way to work with a liaison to make the experience better.
Because those nurses can sit in front of the investigators and boo hoo and say this and that about us, but the absolute truth is - they know The Truth. They know who neglected whom, who assaulted whom, who stole what from whom. And I will stand with them, toe to toe, staring them in the eyes, also knowing The Truth.
I know The Truth.
And today, I finally speak The Truth for you all to hear.
Monday, December 25, 2006
Those who have read here for any length of time know that if I stay the night at my office, the woman's labor will surely peter out and I will have spent the night for nothing, but if I go home to do anything, her labor will speed into overdrive and I will have to pick my head off the pillow and drive back half-asleep. Weighing what to do is one of my biggest challenges when a woman isn't in full active labor.
We sat on my princess bed (well, two of us did, my pregnant apprentice sat on the camel chair) and talked as the afternoon darkened the room and we giggled and yacked about all things midwifery and relationship. How can three women talk so much about birth?! We ask ourselves that everytime we see each other. Do we ever get bored? Never! It is so nice to finally have someone with whom to talk incessently to. Finally. Our families sigh with overwhelming relief.
Dinner time comes and mom feels contractrations are about the same-only-less, so says we should go home and she'll call me in the middle of the night. I sat there on my triangle point trying to figure out which side to go down... stay at the office (20 miles from her house) or go home (55 miles from her house). The girls tried to help, but they were as undecided as I was.
We decide to go to On the Border. You see, On the Border is our restaurant of choice when a woman is in piddly labor that is sure to kick into high gear as soon as we are served 1) drinks 2) dinner. This has happened no less than three times and we laugh that we need to go there when we are in that odd place trying to figure out if we should stay with a mom or go home... "Where's there an On the Border?"
My apprentice lives kind of on the way home, right by the On the Border, and the other lives past where I live. After dinner (where we didn't hear from the mom at all), I took them home with me thinking she was surely going to call, but, once there, she called and said she was going to bed. Each woman called a family member to come and retrieve her from my house. I went to bed the moment they left.
About 2 hours later, the dad called and said things had picked back up and we should think about coming now. It was 10:30pm. I called the girls and got myself together and drove to pick each of them up (neither of whom had slept) and got to the mom's house about 12:30am.
Labor was ineresting. When we talked on the phone, mom said her contractions were every 5 minutes lasting a minute or so, but they were much shorter than that upon observation... maybe 20 seconds. She had to concentrate for a very short time when she had contractions. This was her second baby, but she'd had an epidural and pitocin for the first, so it is, for many women, almost a primip birth. My apprentice and assistant set things up while I assessed the contractions and figured we had a long night and day ahead of us.
Mom was in good spirits and dad was very excited. Their daughter, still nursing, was sleeping. She didn't have an in-depth relationship with dad, so mom had to tend to her when she would awaken. Dad did a great job trying, but mom, in the end, had to go and nurse her back to sleep. We wondered if this affected her labor progress. I believe it probably did.
There were a couple of requests from mom and dad: dad did not want to catch the baby and mom wanted the baby cleaned off before being handed the baby. Not mine to question, just mine to follow.
During the pregnancy, the daughter took a serious liking to my apprentice. I mean, such a liking that she (the daughter) thought I was the assistant and my apprentice was the midwife (it was a great opportunity for her to take a very active role as the lead midwife)! Pretty early on in the care, I'd decided that this would be my apprentice's first catch and a couple of month's ago, let her know it would be. She was demure and sweet and said such kind things like, "This isn't about me, it's about the mom and baby." I would have been all giddy and happy about my first catch, but she wasn't and I thought it was interestingly odd, but shrugged and thought it was just her quieter style. I tend to be more noisy. Surprising, I know.
I needed to sleep, so the "head midwife" spent the night awake with the mom and dad as I slept on the couch a few feet from them. The assistant slept in an adjacent room (where the birth was going to occur... not the bedroom, where the toddler was sleeping). Every once in awhile, I could hear snippets of conversation and got a gist of the contractions... short and sweet... not moaning... I kept thinking, "oh, yeah... plenty of time still ahead!"
About 4:30am, the toddler awoke and dad tried to quiet her, but once that wasn't going to happen, mom nearly jogged to tend to her. I blinked my surprise at her laboring agility and made a mental note of "where would a woman have to be in labor to jog to her child to nurse her?" The dad, who'd given a valient effort, seemed sad that he'd failed.
The apprentice went to bed, the toddler got up, I went to doze on the couch, and the mom went back to laboring in front of the fireplace.
She'd been having some mean posterior-type contractions earlier, so we showed her hands and knees and that position seemed to help. She remained on hands and knees for a few hours and the back pain seemed to subside compared to what it had been earlier when we'd arrived.
I laid on the couch, half-awake, listening to the family interacting - mom eating oranges, drinking juice (she did not like water very much at all, but would drink ice water occasionally) and counting contractions. They were so far apart... and so short. I was sure we were still in such early labor, we could go home for awhile, or at least get out and eat and have some time in a bed before returning.
As dawn broke, I awoke and sat with the mom who pulled in tightly as I talked with her about her contractions being far and short and how they seemed to be in early labor and not as long as she described them. She said that when I wasn't there, they were longer and I said that I believed her! I said that happens often and that perhaps we all needed to go so she could find her rhythm once again and then she could call us when she was about ready to have the baby. I told her I just thought she was still early and would have so much time based on the ebb and flow of the contractions. I offered to do an exam, but knew she would say no because she had expressed no desire for any exams the entire pregnancy and when I needed to do one to determine a head or a butt a couple of weeks earlier, she was less than pleased.
When I woke the apprentice and assistant, we also helped the dad and daughter get ready to go to the store for awhile to allow mom to rest. Her contractions had completely stopped by this point and she was suddenly extremely tired and wanted to go to bed. I thought it was great for us all to give her some time to sleep so she could wake up in labor.
When we drove away, we talked about mom's possible inability to focus on labor with the toddler there - how she literally jumped to her needs and how we thought it was good she was going out of the house, too, for awhile. I thought it was good for all of us to head out for awhile.
We drove down, in morning traffic, to where the On the Border is (45 minutes away), but went to IHOP. We were tired, but talking about the upcoming birth and how nice it will be, how we thought it would be at dusk (we usually see births shift at dawn or dusk) and waited for our food while we sipped our iced tea and coffees.
Mom called and said she was having a feeling like she had to pee every few minutes, like with the contractions, was that normal? I said, "Sure," that she might feel it lying on one side more than another and if her bladder is full. She said she was still resting. We still waited for our food. What was taking so long?
Just as our food was being set down (and damn we were hungry), mom calls and tells me she feels something in her vagina... a bag or something... and immediately I know, the baby is coming - and I won't be there.
The girls hear nothing coming from me, but see my face and I begin digging in my wallet for money and I throw $40 at the assistant and begin slowing and calmly talking to the mom about what she is feeling so I can talk her through this. She is alone.
My thoughts that fly through my head in one flash:
You ass! She's alone. Get her husband back home. Call her husband's cell. Her daughter's gonna freak. Call 911. Offer to call 911. DON'T CALL 911!! Please don't want me to call 911. Stay calm. Please don't be breech. You can do this (the mom). Slow and calm (me). Why am I so fucking far?! I will never make it. Why is it morning traffic time?
And probably a lot more expletives I conveniently forgot.
As the assistant pays, I remember getting into the car, me driving, and telling mom how to stay calm and how to deliver her own baby, that is, by the way, in the caul. I tell the apprentice to call the dad - mom has to repeat his cell phone number about 10 times - and tell him to go home NOW - and that's all he hears and hangs up on her. She calls him back and tells him if he goes in the house and finds a baby, to please put a blanket on the baby, which further freaks him out.
I stay on the phone with mom, talking to her gently throughout while careening through rush hour traffic (sorry everyone) and she moves from the toilet to the bedroom where she wants to deliver and gets on her hands and knees. I reminded her that she knew how to do this instinctively, that she had the power... anything to keep the banter going. I told her I had to offer to her to call 911, but that I believed in her and I knew she could do this alone if she wanted to and that we were calling her husband back to her. I had to let her know I wouldn't make it to the birth, but I wouldn't leave her on the phone.
Dad gets home about 9 minutes after we call him and we talk him through the birth, which happens about 4 minutes after that. When dad got on the phone, I asked him to center and focus because he'd been out in the world and running and he needed to be centered to catch his child. He was fantastic as he took a breath and I could hear him audibly relax.
He kept asking what he should do and I stressed making sure the baby could breathe once the baby was born if the sac was still over the face. He said the sac was coming out and he could see the head was coming out... he was giving me the sizes in coin sizes, but I think they were European coin sizes. As more and more of the head was born, he started telling me the head was purple.
At one point, I thought he told me the baby was born and not breathing and I told him to take the sac off the face and rub the baby's back... I didn't hear her crying (they knew it was a girl)... and I was getting scared. Then he finally said only her face was out and looking at him, I relaxed and said she would come in a moment and as I said that, she was being born and cried right away.
I was thrilled. Can I say now that every pregnant woman should be required to have speaker phone?
They got blankets on her (I'd had him turn the heat on 80 as he ran in the door and turn the heating pads on) and then I told them all they had to do was just sit with each other and wait.
We arrive 19 minutes after the birth. 28 minutes to get about 45 miles in morning traffic - not too bad. Too late for the birth, but we made it for the placenta!
We came in (after calming before entering) and set to work assessing - all was well, but there was some bleeding we had to tend to. The placenta was born with some assistance, mom needed a shot of Pitocin, the baby's cord was cut (it had long stopped pulsating), and we cleaned mom and the bed up before righting the room and getting the things that we no longer needed out of there.
Mom was pretty stunned and it took a couple of days before she was happy with her birth experience. She is proud now, as is dad. Remember, he did not want to catch and she wanted the baby cleaned off before holding her; neither happened. But, he was promoted to midwife and she was the first to hold her child - both are very proud to have been alone when their baby was born. The daughter was scared and ran out of the room at the moment of birth, but she has acclimated to her sister just fine and is even finding a way around tandem nursing.
Amazing what we can do when we have to, isn't it?
So, my apprentice didn't get to catch and even when we were going to have her catch the placenta, that didn't work out either because of the bleeding, but she did get to cut the cord and did that very well (it was her first time). She told me that throughout the pregnancy, she just didn't see herself catching this baby. She'd said that she couldn't even picture the actual birth itself, which none of us could either (and that was odd), but now we know why! I still don't think she'll be as giddy as I was anticipating my first catch, but perhaps she'll be able to visualize it.
Oh, and one final note: Postpartum, I looked over at the bookshelf in the room where the baby was born and what was there but Anne of Green Gables. I laughed and we wondered aloud how many births Anne has witnessed! We know of at least two in a row this December of 2006.
Thursday, December 21, 2006
During the pregnancy, she agreed to allowing me to draw a prenatal blood panel and listen to the baby's heart rate. Blood pressure and measuring the uterus are not the most crucial things for me, but she allowed us to do those, so we did. All was fine and dandy.
Our biggest obstacle was getting to mom's house before the birth (she lives far from my office and even further from my house) and extensive counseling was done regarding staying close to the ground and not being on the toilet if she was alone during the moment of birth. Mom really felt we would make it this birth and the assistant and my apprentice also felt we would, but I wasn't so sure. I just wanted all the bases covered, so made sure she knew: low to the ground and off the toilet!
She knew labor was going to come soon by contractions that were annoying, but they stopped periodically over the few days before they wouldn't actually stop. Once the didn't totally stop, she still could sleep through them for some of the night, but she walked and wandered and puttered around the new house to keep her mind off the contractions and on other things.
Her best friend, another client of mine - the client of mine that transferred to the hospital and then subsequently hemorrhaged at the birth - spent the day at her house entertaining the two younger kids, feeding and watering her (the laboring mom) and taking cool pictures of her fixing the heater (with tools and everything). The two dads also hung out that day playing poker for some sort of yogurt balls (I'm sure someone will understand what I am talking about) and then when it got closer to dark, the laboring mama thought it was cool to have us mosie over - not that anything had changed, mind you. She'd been in labor for about 17 hours by this time - a new record for her. Her total labor was 21 hours. We were there for about 90 minutes before the birth.
I gathered the troops (I drive them to births when we have time... it's a nice trip back and forth) and we headed up, wondering if we'd make it or not. When we got there, we saw our previous client holding a baby and wondered if it was hers or the new baby. It was her own. The new baby waited inside the mother for the midwife to come.
It was a hootin' party inside! Kids hollerin'. Dads laughing. The tv playing some sort of kid's cartoon. Something baking. How festive! Where was the labor going on?
Oh, there she is. In this side room over here.
We walked over to the room and there's mom hunched over a birth ball watching... what's this? Blinking, I had to laugh outloud.
I've experienced a whole lot of different styles of relaxing in labor. I've written often about how I own every Enya, but if I never had to hear her again in a labor, I would be thrilled. Between she and George Winston, they are my hands down faves for most over-played labor music, although hypnobirthing tapes are outweighing George nowadays.
I loved this mom after spending time getting to know her, long before I was ever her midwife, but what she chose to watch in labor sealed our fate as "kindred spirits."
Anne of Green Gables & Anne of Avonlea
Yes, it's true. She spent her labor watching the tales of Anne Shirley and Gilbert Blythe and life on Prince Edward Island, Canada.
Suddenly, I knew we could be lifelong friends if she could/was watching this movie in labor - in deep and heavy labor! A woman after my own heart.
We pulled in the supplies from the car, but most of them stayed in the living room or dining room and we brought in just the actual birth essentials (gloves, clamps, mirror, flashlight, etc.) and got the blankets warming on the CPR board (that we surround by two heating pads). We ended up taking one set of vitals and two sets of heart tones on the baby and that was it because all was fine - and things progressed quickly.
After the initial shuffling of bodies into the room, we got settled: I was on the bottom bunk with my apprentice, the assistant close to the tv, the mom on her ball or kneeling on her ball in the center of the room, the friend wandering in and out and the kids doing the same.
Eventually, the one dad left with the friend's kidlets and the youngest child of the house fell asleep so dad put her to bed.
Now, this dad wasn't going to have a part in this birth. We assumed it was cultural and it very well might have been, but it was also a pretty big assumption on our part. He'd left for the UC and mom had her friend (the same one that was here this time) there to catch and he came back when everything was cleaned up. That was the plan pretty much for this time, too, except this was nearing midnight and there wasn't anywhere to go with two sleepy kids. Near the end, he stayed in one of the back bedrooms (I think).
The saga of Anne continued as tension between her and Gibert rocked back and forth - much the same as my client on the ball, although she barely moved or breathed differently than you or I are doing even now. If you didn't know she was in labor, you might not have even been able to tell. She got up and waddled to the bathroom every few minutes - the most obvious strenuous part of labor looking at it from the outside.
Many women's contractions are regular and rhythmic, but this woman's were, down to the second, 5 minutes apart from when we arrived. When Diana Barry got married, her contractions moved down to 3 minutes apart and her breathing quickened slightly - eyes closed more time than opened - and we could see things were coming closer.
You know in poems and stories how Death is spoken about like a person or an actual being? How Death walks in the room or you can smell Death? (I hate having to talk about that like this in the middle of a birth story, but there is no other way to talk about this but this way.) Well, at this birth, Birth walked in the door.
Never, in all these years of working, have I ever, ever, ever experienced such a tangible moment of clarity that Birth was imminent without any outward signs to tell me so. There was no bloody show. There was no pushing. No contraction. No grunting. No sighing. No crying. No words from mom at all. There was one thing only.
Birth walked in the door with her arms filled with the scent of herself.
As if we'd been sitting in pitch black (no scent) and someone (Birth) turned on the lightswitch, the scent of birth was not there and then, just as suddenly, was so pervasive my head swam in the headiness of the scent of this woman's oceanic wetness that hadn't even spilt a drop anywhere outside of her vagina yet. I looked at the women around the room.
My apprentice, my assistant, the friend/my client - did I say outloud, "I smell birth"? or did I just say, "It's time to wash our hands"? Somewhere before or after washing my hands I sat on the floor and turned the tv off while the friend turned the video camera on and we hunkered down on the floor and watched as mom's amniotic sac burst against the back wall and she laughed thinking that was big fun. 4 minutes later the baby was born.
On hands and knees, mom let the baby come down and we watched as she came down somewhat acynclitically (thank goodness she was small!) and I encouraged mom to reach down for her baby and she got one hand down, but couldn't quite help her up so the assistant helped the baby out and up through her legs so she could bring her baby up to her own chest.
We brought warm blankets over to let mom dry the baby - no hat! (I have this thing about babies and hats, you know, and this mom didn't want a hat on her kid. At the home visit, I said that I really wanted a hat on the baby since it was going to be cold and she said, "that's nice" to me. I just laughed, knowing where I was going to go with any further hat discussion.)
Dad heard the baby's cry and walked by the room and said something like, "already?" and then something along the lines of "yuck" before walking away. We closed the door so we could get things cleaned before he had to see the baby again. Closing the door also made the room warmer.
I'd made a concession (my own) about the hat by bringing an extra space heater (I carry one in the winter anyway) into the room and we had it going along with their space heater. About 5 minutes after the birth, a fuse blew and there was suddenly NO heat in the room at all except by all of our body heat. I had to laugh at all my planning ahead. Someone tossed a big blanket on top of mom and baby and I hoped for the best. I was glad we weren't in Minnesota.
We cleaned things up as mom was fed and juiced and then she trekked to the toilet where she said she knew she tore. I asked if I could look and she said, "nope," and I said, "you won't let me suture if you tore where I could suture and make you more comfortable?" as she sat wincing her face all scrunchy on the toilet. "Nope," she said. Eek! Okay. breathe
We cleaned up the room, got the bed ready for her to climb into as the dad got the fuse thingie fixed. I checked over the baby really quickly (with mom's permission) while she was on the potty and took her temperature (she was a girl!) and it was a chilly 96.9. I expressed my concern about her temp and wrapped her up warmly and suggested a skin to skin and under the blankets once they were together again. I kept her close to me until mom got back.
We loaded our gear back into the car and headed out a lickity-split 90 minutes after the birth. Only one other time had I left that fast after a birth - after my now-apprentice's hands-off birth, It still felt bizarre. So much was left undone! I charted "mother refused" on the newborn exam, the vitals, the measurements, the postpartum instructions, the place where it asks if mom had a tear or not and whether she was sutured or not. So many things normally/typically done that just weren't done. I marvelled at my groove and how I squirmed stepping out of it. I'm sure it was a great lesson for me to experience. Couldn't have been with a better group of women, that's for sure.
So, after the birth, in the room, there was me, the mom and her new daughter, the friend/my client, my apprentice/client, my assistant, and the new mom's daughter and we were giggling and having a sweet time when the husband tried to get the older daughter to go to bed. There was way too much energy to get that to happen, though. I laughed thinking of all that chick energy zipping around in there and what an honor it was to be lathering ourselves in it... how very blessed we were to be invited into this woman's space where she opened her door and showed us the room where she let Birth walk in and set down, right on her lap, a beautiful baby with the middle name of "Anne."