Sunday, December 26, 2004

A Series of FORTUNATE Events!

Client came for childbirth class on Sunday and looked kinda funny.

Near the end of class, she asked me for a pad and I raised my eyebrows and asked why. She said she couldn't stop peeing and I asked if I could have some of her pee in her undies. She laughed (she is a joy-filled client) and I said perhaps she had ruptured her membranes. It was clear, so she wasn't sure, but it had started leaking at 2am (it was now 1pm the same day). I got my prenatal bag and nitrazine paper and checked and ayup, it was positive for amniotic fluid. She had no contractions. I did a sterile vaginal exam and she was 1-2/40%/-2. I was disappointed and concerned.

This client had also chosen to do a GBS test and was positive. She did the alternative regimen, but remained positive 2 weeks later and wanted antibiotics during labor because of this.

We were on a time limit.

I gave the client several options including the hospital induction route... cimicifuga and cauliphylum; castor oil; nipple stimulation; visualization; acupuncture. She was game for them... all but the hospital one.

On the way home, she called the acupuncturist who came to her home within an hour. She had begun the C&C in the office and was taking that every 4 hours. She knew to put nothing in the vagina and was taking her temperature every 4 hours, too. I was going to meet her at 7pm (18 hours post-rupture) to start IV antibiotics.

I got to the client's house at 7pm and loved her house! She had just moved in with her roomate... her man is in South America having just gotten his visa to come to the US. She was going to move to a local Indian Reservation to birth at her mom's (she wanted a teepee birth, but that didn't pan out; she is Native American), but knowing that there was a possibility of transferring to the hospital that was a few miles from her own home, she decided to stay home.

The CNM in the practice came and we had a long talk about what might come down the pike without labor even a hint. She tried to get a vein three times and missed. I was going to try next and then kept thinking: save something in case you go to L&D.

It was 9:30pm and her family was starting to assemble. We needed to make some decisions.

She had had 3 acupuncture treatments (was having her third at 9:30pm) and not a hint of contrations.

After discussions, she decided to move to the hospital. Never ever did we "see" this birth in the hospital. It was very odd.

So, we get to the hospital at midnight and she is admitted from Triage by 2:15am. She decided to fudge 12 hours off her real rupture of membranes time. She didn't come up with that idea on her own. We offered ideas of how to speak about her membranes and it worked. "I wasn't sure, but I thought I started leaking at 2 or so." and then I piped up and said, "and so I checked and she was positive!" They wrote 2pm instead of the true 2am. Her sterile VE showed 1-2 cm/40%/-2.

Once in L&D (we had a HUGE room), I finally sat with my leg up and the drama of admitting began. One nurse tried to start the IV twice and blew the veins the same as the CNM did at the house. Another nurse came in and didn't even feel and started the IV within seconds. I want her to start all my IVs!! The pit was started and the long night continued.

I went to the car to sleep at 3:30am. Her mom slept on the pull out chair thingie I had my leg up on. I awoke at 6am and went back in. Nothing happening. That is how it was all day. The pit was increased every 20-40 minutes and then by noon, she was at the max amount. A nurse took me aside at 8am and asked if I knew where this was going. I said that I did. The OR was what she meant. She said she would probably have the baby by noon.

Later, we were told the doc would be in around noon and a decision would be made. No vaginal exams until the doc. I told the client and her mom the doc wouldn't be there until 1:30. At 3pm, a new nurse (we had a bevy of nurses) came in and said the doc was held up at another hospital and gave orders to up the pitocin.

Very shortly after, the client began feeling the contractions and having to breathe through them. I was extremely tired and called my midwife-friend in to help me. I needed to sleep. She got there quickly, but by the time she got there, I didn't want to even go sleep in the car lest I miss something!

The doc got there at 5pm and did a vaginal exam. She was 2/80%/-1. It didn't look good. But, there was some change, so she wanted to wait awhile and see what happened. Maybe another hour. The nurse (and I) thought she heard some late decelerations and the doc ordered an intrauterine pressure catheter (IUPC) and the doc, 2 contractions after the last exam, put the IUPC in and commented that mom was now 3 cm. Woo hoo! Hope!

Nurses would say, "you know, she will be having this baby one way or another by midnight" and I believed them. I couldn't believe we had bought so much time so far!

With the IUPC in, the nurse became alarmed because for the first time they could SEE the contractions my client was experiencing. She is a master meditator and she was extremely peaceful and none of the nurses thought she was feeling a thing when she was, in fact, doing slight breathing for quite awhile. She didn't get "working-feeling" contractions until 3:30pm or so, though. When the nurse saw the contractions on the monitor, she stood and watched because my client did NOT have an epidural and was experiencing massive contractions. For those that know: the TOCO was nearly zero'd out... 3-5 being the baseline. When she had a contraction, it would go to 80-90 each time... some of them off the damn paper and higher! The other midwife and I were worried about the client's uterus! The alarmed nurse turned the pit down after about 3 minutes seeing the strip. She was having contractions every 45 - 60 seconds and while they were short, they were hard. She ended up turning the pit down 4 times before it settled where it did.

Now, the doc was supposed to come back after feeding her cats (after her 5pm visit), but she was called to the other hospital again and wasn't there. My client labored on. I took a nap from 6:30-8pm. I thought I was going to throw up I was so tired. I laid down in my car and shut my eyes and then the other midwife called me. 90 minutes had passed! I went back upstairs.

A vaginal exam at 9pm found my client 3/100%/-1. Change! A long discussion about getting an epidural or just asking for a cesarean began. The other midwife and I shared our thoughts and in the end the mom decided to let the doc make the choice (via phone). The doc voted for epidural because she was... you guessed it... at another hospital! Wheee!

The epidural went in at 10pm. Quick, easy, and comfortable. Mom went to sleep and the midwife and I went to eat. We were in the lobby yacking and heard a call to her room so we hightailed it over there. Apparently, at 10:30, she was 5cm and now, at 11:15pm, she was complete!

Mom felt some urge to push and pushed really well with the nurse's fingers inside showing her where to push. All those things she learned in class to not do were inacted. She laughed a lot about that happening. Even the exercises about working with pain so it doesn't overtake you... she had to focus and make the pain hurt or her contractions would peter out and go bye bye.

So, she is pushing and the nurse is readying the room, so I ask if I can sterile glove and help my client. Sure! she says. I glove up and work with the client about where to push. We get the client to put her hands in her vagina and feel the head and she does over and over. Joyous! Her face was filled with bliss (and we said as much several times). She was ecstatic that she was having a vaginal birth after being led all the entire day that a cesarean was where she was going. She was more than bliss-filled.

The doc was called and she got there, gowned and sat behind me watching. As she was gowning, I said to her to just let me know when she needed me to move, that I would jump off the bed the second she needed me to. I worked with the client until about 3 contractions from delivery and the other midwife shoo'd me away from her vagina. I asked her later why she didn't wait for the doc to say something and she said she was the kind of doc that wouldn't say anything and then be very angry afterwards. Oh. So, I trust my midwife-friend, so moved and they broke the bed and put her feet in the pedals inbetween contractions and the head came out and the baby was born and it was delicious and fabulous and wondrous all at once! We all wept with joy!

It is a boy and he is gorgous! A Native American mom and an Hispanic dad. Oh, how yummy he is. 8 pounds 10 ounces. Small tears that needed repair (I think from the doc's pulling on her vagina... I was very gentle and had no blood when I was in there), all inside.

The baby was doing great, but has had some transient tachypnea and they were especially freaking because of all the time with ruptured membranes and the GBS issue, but he is fine.

The baby did end up with ABO blood incompatibility and under the bililights for a couple of days. Mom just got home and told me the baby continues with some tachypnea at times. We'll watch that. They gave her a lot of education about GBS infection, so I won't have to harp on her or anything.

Because of the ABO incompatibility, this baby would have also been hospitalized after birth. His jaundice levels rose high and went high FAST (15 at about 30 hours postpartum) and while the bili experience was not as positive as my last client's (nursing in the bed, keeping the baby in the room under the lights, etc.), mom is coping well and has been out of the hospital for a day now (the baby is 6 days old now) and nursing is moving along beautifully!

What a cool story of hope for me. I am constantly surprised and amazed.

Wednesday, December 01, 2004

Forced Cesarean

We drove 90 miles at 80 mph to get to the hospital that was supposed to treat us nicely... kindly. We passed at least 8 other hospitals along the way and left two, much closer, behind us. We had been led to believe that the university hospital, a hospital that also had a birth center on a separate floor run by over a dozen CNMs, would be a safe space for us midwives who had to transfer a client in the midst of labor and birth. Absolute emergencies, of course, went to the closest hospitals, but this wasn’t an emergency. Yet.

We drove in a caravan, me behind the laboring client whose husband was driving, the other midwife right behind me and then family members behind them. Thankfully, most of the evening traffic had abated, so the gang stayed pretty much together until we got a lot closer to the hospital downtown.

I kept begging God to let the baby come in the van. Please, please, please just let the baby come now.

When we left the house, mom was 7-8 cm and the baby was a –2 station. A huge difference from complete and 0 station before the hugely bulging membranes ruptured. Sometimes membranes not rupturing make me angry! They aren’t always misleading, but this time, those membranes told a whole different story than when they were gone and the head got to tell the story. At least the fluid was clear. I was so worried the fluids wouldn’t be clear once the membranes broke, but that was a pleasant surprise. It is one reason we don’t like breaking them; what we don’t know won’t scare us.

The other midwife and I paved the way for the client who was waiting for a wheelchair to bring her up. Does she want to try for a vaginal birth? Well, we doubt that will happen at this point, but, of course, if possible! The charge nurse tsk tsking in the background as she was assigned a bed.

Into the room the entourage goes and mom is hooked, hollering, up to the monitor and asked a dozen questions. Everything is going too fast! It isn’t an absolute emergency. A female resident comes in and says she wants to check my client and she submits to only the 4th exam of the labor. She has a cervical lip and the baby is +2. What?!? She is fractions of inches from having this baby vaginally! The doctor wants to see if she can lift the lip and has my client push with all her might as another nurse is prepping her for an IV and others are bustling about the room. She pushes as best as she can after not pushing for the entire 2 hour journey down to the hospital and into that bed and the doctor takes her hand out and says, “sorry, don’t think it’s going to happen.”

And that’s it.

And that’s it?!

My mind races as I think of alternatives to a cesarean for a cervical lip with a baby at a +2 station (+4 is the baby’s head visible at the entroitus). I mention to the doc that some midwives will use ice in a sterile glove on a swollen lip... might we try that? She said she wasn't comfortable with that, but interesting concept.

I discuss with the client... quietly... but quickly... that an epidural might do the trick. An hour or two without pushing/pressure might relieve the lip’s pressure and the baby could come sliding out. Positive, loving words of encouragement, her perfection, how great she worked all the way down from another county. I nurse starts the IV angrily in the back of her hand causing my client to holler and wince. The anesthesiologist is going to come in now, another nurse says, to discuss her spinal for the cesarean.

Somewhere in all of this is the absence of the CNM who was supposed to meet us in the room. She had an emergency transport from upstairs to L&D, so couldn't meet us. Had that happened, we might never had experienced the story below.

Later, another CNM told me that the new slew of residents and attendings hadn't been sufficiently brainwashed by the CNMs yet to leave things alone. They were eager to cut and learn. Why on my client?

I note a waif of a woman at the bottom of the bed staring, but say nothing to her as I discuss strategy with my client; there are so many people in the room already. The nurse walks out the door and I let her know that my client would really like to discuss an epidural so she might have her vaginal birth after cesarean and the curtain drops in a huff.

Waif woman, it turns out, has been eavesdropping and also happens to be the Attending Physician; the Queen of All Decision Making. The attending says she just doesn’t see how a vaginal birth is going to happen... mom has been through SO much already, isn’t it time to just have the baby in her arms now?

The anesthesiologist comes in and does his Spinal Spiel... checking for dentures, size of the mouth and throat, going over allergies, discussing previous surgeries... and the other midwife, gently, touches his shoulder to explain that mom had to be poked three times for her epidural last time. He shrugs her hand off as if she were a poisonous spider without any other acknowledgement of our presence.

Mom, in so much pain, enduring the indignities of these people’s questions, being poked, prodded, having the monitors adjusted over and over during contractions (they always forget that not everyone has epidurals and adjust them during contractions)... all she wants is a moment of relief.

She says to the anesthesiologist, a male doc, that she wants an epidural because she wants to try and have a vaginal birth. The attending butts her head in there and says she doesn’t think that is going to happen... and look! the baby is starting to show signs of stress now. Look at those late decels. What?! I go to the machine and see no late decels, but plenty of head compression decels and find hope in them... wanting to scream at the attending for her hate and venom of disbelief in my client and her ability to birth vaginally.

I write this in a linear fashion. This was not linear. This was layer over layer of fear and anger and waves of loud and huge contractions and disbelief and shock and noise and undermining and lying and people talking all at once and hurry! hurry! hurry!

My client asked for a few minutes with her family, leaving the other midwife and I with her husband as she said she really wanted to stop the pain and to try for a vaginal birth. I asked her if she wanted to see the strip because I didn’t believe they were late decels at all and she said she couldn’t look as yet another contraction pulled at her body.

The docs came back in... three now... the original resident, the attending and the anesthesiologist... and the CNM, too... and as my client asked for an epidural, the attending lowered the client’s bed some... pointing to the monitor showing what a hard time the baby was having now. There wasn’t time to see anymore. It was time to go back now!

The anesthesiologist began discussing the epidural and that it wouldn’t last long... maybe two hours... and it wouldn’t be able to be used for the actual surgery. She didn’t care! The attending had to have given him a glaring, evil look or kicked him under the bed or something because then he started this whole other voice.

A grapeseed of evil surrounded by a honeycomb.

Now, if you have an epidural in here, if we have to go back, I just might not be able to re-dose it. Sometimes it’s hard to do that.

Remember, there is a lot of commotion still going on... still so much noise and activity. But he created this tiny pocket of silence where only the client, the husband, the midwife, and I could hear.

So, if you can’t be re-dosed, then, gee, I guess you’ll just have to have general anesthesia for your surgery.

My head swirled. I thought I was going to vomit as his threat washed over me. I wanted to take the IV pole next to me and smash his arrogant head with it, letting him feel the agony he was causing other women at his hands.

There were no options. They evaporated with his remark. This man, no matter what, was going to have needles next to my client’s spinal cord and he had the power to make that experience hell or tolerable. My only regret is not begging my client, just one more time, to try without medication. It was ludicrous since she’d been in good active labor for about 50 hours at that point; it wouldn’t have been fair to do so, but since it is human nature to replay things a thousand times, that is my only major regret.

I wasn’t sure if my client “heard” what he said, but I leaned over and whispered to her, through tears, “you have to go back now” and she said, “okay.”

Promises were made about keeping mother and baby together, Duramorph being used so mom could be pain-free long, but still mobile, and mom was wheeled out of the room with the chaos, leaving dad, the other midwife, and me.

Dad was in the OR for the birth and remarked that someone had to go to the end of the table to dislodge the baby’s head from the pelvis before she could be born abdominally. Another wave of nausea swept over me.

Mom was taken across the hospital to the “overflow” recovery room... the PACU... where no babies are allowed, where moms are not allowed any visitors at all... where the recovery period is 4 hours as opposed to the 2 hour max in standard OB Recovery Rooms. The baby was taken to NICU and found, quickly, to have low glucose. (All this happened within the first hour postpartum.) The nurses wanted to give her a bottle of formula and when dad refused, they readied an IV solution of dextrose! An IV!! Through careful and kind negotiation, dad convinced an NICU nurse to take the baby to the PACU to nurse on mom and, blessedly, they did (after much arguing about policies). The baby’s glucose never went down again.

Mom was left alone in recovery despite my trying to get in. When we sent the baby, the mother-in-law (MIL), an NICU nurse herself, tried to stay, but the client said she wanted to sleep. The PACU nurse made snotty comments about mom sleeping so well until the family interrupted. I asked dad if he told the nurse to shove it and that mom would MUCH rather lose some sleep to nursing than sleep through the first 4 hours postpartum without nursing. He said he said something to that effect.

Mom's belly incision was made above the old incision... and in a drunken fashion. The resident's first incision on a belly? We are waiting for the records to see what the uterine incision will be... hopefully, the same incision, but, considering the surgical and emotional punishment foisted on her throughout her short L&D experience, I wouldn't doubt if they gave her a vertical incision on her uterus.

After the baby nursed, I gathered myself together, said my good-byes to the troups and went home. I’d gone to the mom’s home 23.5 hours earlier, fully anticipating a wondrous and amazing birth. And here I was going home, defeated. Feeling so useless as a midwife. Feeling powerless as a doula. Feeling useless even as a friend.

I sobbed the entire way home.

Saturday, November 13, 2004

25 Hour Precipitous Delivery - Part 3

Once we were all assembled in the hospital, things lightened up. The un-laboring mom was glad the doc was there. The grandmother was thrilled we were there. Dad, calm as always, was fine we were there. I was very disappointed, but also very relieved we were there considering the issues at hand. I asked one of the other midwives to come and give report before leaving, so she did and I was grateful. The other midwife left before we left for the hospital.

Our nurse was fantastic. She was kind, respectful, cheerful and wanted my client to have all the things she wanted even as her plans totally shifted from a homebirth.

An anesthesiologist came in to start the IV and had to poke twice before getting it into her antecubital (inner elbow)... (we were vindicated!)... a horrid place since she couldn't bend her arm at all. I asked for an arm board, but they had to order it from the pharmacy. It still hasn't come in 2 weeks later. Mom did her best to not bend the arm, but worried most about nursing.

Once the doc came in, he did a vaginal exam and found her to be about 5-6 cm. Continuing to progress without contractions, he was glad she was there, too. He asked if the pit had been started yet and the nurse laughed and said she was still getting everything together. The client asked if she could have some cranberry juice... said that was the only reason she agreed to come into the hospital... and the kind nurse said she didn't think that would be allowed. The doc, sitting in the rocking chair across the room, said, "she can have as much as she wants!" and the nurse quickly brought one of those pitchers filled with cranberry juice and ice! I expected those little half cup thingies; she did good.

Mom asked if she could get the IV out right after the birth and the doc mentioned her history of bleeding and that perhaps they will leave it in for awhile. The nurse said to the doc that usually the IV is left in until the woman has voided (peed) twice. The doc laughed as he looked up at the nurse and said, "so, you void once and I'll void once and then we'll take it out!" We all laughed. I thought that was indicative of the kindness of this doc.

As we did introductions, the doc got around to me and said, "I remember you," as he shook my hand and I repeated my name. And I had hair 2 years ago!

So, the pit was started and every 20 minutes it was moved up a degree. We ordered food, ate food, including mom inbetween the contractions she was beginning to have about 2 hours into the pit upping.

At one point, I looked at mom and told her that we had spent so much time on the preparations for her birth, I hadn't totally explored how to support her physically/emotionally during contractions. We'd assumed she wouldn't have any and here she was, having them now. She said she would let me know how I could help when it got to that time.

Time passes and our lovely nurse has to go home. We begged for a nice nurse... PLEASE find us THE nurse that is your twin... and she said she would do what she could. Apparently, she couldn't do much. We got a brusque and disrespectful-of-contractions nurse who apparently forgot my client didn't have an epidural. She tried to move the monitor belts during contractions, talked when it was inappropriate, and was just too fast zipping around the room. We gave her about 10 minutes before I told my client that I wasn't so thrilled with her. She said she wasn't either and we strategized about asking for another nurse when the phone rang. I picked it up and it was the nurse who'd just gotten off shift. Puzzled, I listened as she kinda whispered that we might really consider asking for another nurse. I couldn't believe what I was hearing!! Never, in all these years, has a nurse EVER called to say that about the nurse that followed.

I went to the nurse's station and let the nurse sitting there know we wanted to see the charge nurse and re-entered the client's room to hear the grandmother, a charge nurse herself, having a mini-fit about our asking for a new nurse.

Instead of getting a new nurse, labor zoomed into high gear and the client began shaking and sweating... her typical THE BABY IS COMING NOW signs, so she told the nurse to get the doctor. The nurse buzzed the nurse's head on the bed and then reconsidered, saying she needed to do an exam before calling the doctor... that she needed to make sure mom was complete. I told her I was sure she was complete, but the nurse told me to examine her or she would and I wasn't about to knowing the baby was probably right there!

The fuzzy nurse voice over the intercom said, "May I help you?" in that muffled microphone way of hospital's and the nurse said, "never mind" at the exact same time the client SCREAMED: GET THE DOCTOR IN HERE NOW!!!!!! Within seconds, the room filled with nurses who wanted to see what was going on and the mom screamed again to get the doctor because the baby was coming. The nurses left and our nurse was tsk tsking the client and then the nurse looked right at me and said, "glove." I stood looking at her thinking, "she wants me to open her gloves? she wants a glove?" and then she yelled, "glove up!"

Oh my god! She was going to have me catch?!? I washed fast and then gloved and told dad to glove and I grabbed a washcloth because mom blew her bottom out last time and we were going to work to go nice and slow this time. She had another contraction and the head began showing and then the doc walked in.

As he gloved, I removed mine and moved to the side of the bed, near mom's head. She was stirrup'd, draped, and then the baby, coming out without a contraction, continued progressing outward. The stupid nurse was to my left and was exhorting this mom to PUSH, PUSH, HOLD YOUR BREATH! And I glanced at her and wondered what the hell she was looking at when she seemed to be looking at the client's vagina. I whispered in mom's ear, "slow, slow, you don't need to push, the baby is coming nice and slow... good, good... that is perfect..." blah blah blah. It was all overlaid with the family exclaiming how much of the baby was showing and mom not pushing as the baby slid out.

I'd missed a hospital catch by about 60 seconds.

Pitocin was pumped into her IV and an IM methergine was injected. There was no bleeding. Her placenta was born within a couple of moments, but still no bleeding. I was so relieved and firmly believe that having the IV in place with the meds kept her safe. There was no tear this time and mom was thrilled!

Despite the stupid IV placement, mom began nursing her 4th daughter and we talked and shared thoughts and after about 90 minutes, it was time for me to go. The rest of the family had already gone.

The next day, I talked to mom who told me the IV was still in. She'd hemorrhaged 4 hours after the birth!

I felt weak as I imagined that happening if she'd delivered at home. Even if we had had the IV in... even if we had kept her from bleeding initially... if she bled 4 hours postpartum, she would have been alone and had to be transported - alone. Our decision to transfer was the right one.

Mom, 2 weeks later, is doing well. There are sad moments of not having her so-hoped-for homebirth and we'll keep talking about it and working through it.

4 beautiful girls.

An alive mom whose bleeding was controlled with meds.

How blessed to live in these times.

25 Hour Precipitous Delivery - Part 2

Labor started and stopped several times throughout the night and day. Walking, thinking, sitting... sometimes they would come... and others, they would go. There didn't seem to be much rhyme or reason to their flow, and it was frustrating at times, sleepy at others.

I was asked to do a vaginal exam a couple of times (by the mom) and could see that she was dilating even without contractions. Starting at 2 cm, she then was 5 cm several hours later.

After about 15 hours, mom tried some blue and black cohosh, but the two doses caused dips in the baby's heart rate... from the 150's down to the 110's... so we abandoned any more of that. I didn't want to move to castor oil either, because if the baby was having moments of difficulty with B&B, then what would she do with something more aggressive?

The two midwives working with me were great. During the night, they spooned on the couch because it was freezing in the house. I slept in the car for awhile, then in one of the children's beds, setting my phone alarm for every hour to listen... and then not listening at all from 3-6 am when we sent everyone to bed and we all slept for 3 hours straight.

Once up, that was when we tried more walking and the B&B, and at one point, I was really, really tired and needed to sleep and one midwife, too, said she would, so I asked the third, the only one there not being paid, to hang out with mom. She had this great idea to get her out to walk. (We'd all suggested it for HOURS for her to go out and walk... seeing expanse, not walking in circles around the back yard, really walking and not strolling... but she wanted nothing to do with that.) I chuckled as I readied for a nap, knowing mom wouldn't be going out (modesty, needing to pee lots, and headstrong desires), but was amazed when I turned the corner and she was putting make-up and clothes on to head out!

I went for my nap and awoke feeling a distinct shift in energy. Finding everyone, mom was on the birth ball in her pjs after her walk(s) and having an inward energy.

This client lives at her in-law's home, so we spent most of the labor in her bedroom. Very modest, she sat on the ball in there, laid in the bed, sat on the chair occasionally. She also is a doula and knows the ins and outs of getting labors going/continuing. She knew her history of hemorrhage. She knew she could/should be out walking more. She told us as much.

She knew the energy of those around her could totally affect her labor.

Yet, she sat in the room, laid on the bed, and had invited her mother, an OB nurse, to the birth anyway. Her mom, from pregnancy, was disturbed about the homebirth. She hadn't been told about it last time because the client knew what she would say. After the transport experience, mom was so angry she would attempt a homebirth again. 4 midwives showed up at the 36 week home visit and answered all the mom's questions.

Yes, we understood the risks.

Yes, we were going to put a hep lock in (saline lock, actually) and have a 250 ml bag of LR with a pit and a meth in the bag for her.

No, we didn't want a homebirth if it wasn't going to be safe.

Yes, we all have practice with hemorrhages. (2 LMs, 1 CNM, and me)

Yet, once in labor, mom was a pill. She could not stop making comments about how dangerous her daughter was being. I could tell she was really trying to not be so mean (it could have been worse?). Sometimes. Just like docs play the "if she were MY daughter..." card, this mom also played that card: When their daughters (meaning us midwives) are the ones in this position, they can make their own choices.

Never underestimate the power of pitocin.

You have three other kids to live for, why are you putting yourself at such a risk?

How long will you give her (with her membranes ruptured)? (My answer: until she delivers)

During pow wows together, one midwife wanted to find the psychological reasons for her labor dystocia. I didn't care. I also knew the mom better and knew her level of compliance and desire to actively participate in her pregnancy, labor, and birth. It just wasn't her thing to DO something. Later, when the walking midwife's husband brought their baby to nurse (she'd run out of the house without the pump), the client told me how much she hated the walking. The midwife exhorting her to walk faster and she walked so much she sweat. At one point, she begged to go to the bathroom, and when she opened the bathroom door afterwards, the midwife was there again, ready to walk and walk. The client, momentarily compliant (read: open to the power of suggestion), headed out again. When she got back to pee the second time, she said she felt yucky so wanted to shower. The walking midwife thought that was a great idea! She could stimulate contrations in the shower... nipple stimulation and more. My client took a 3 minute shower and reappeared with her pajamas on. The walking midwife was so disappointed they weren't heading out again.

I didn't have the energy to deal with the "why's" of the clients desires. Why did she invite her mom in the first place? Why did she allow her mom to say these things outloud? Why didn't she tell her mom to shut up? Why did she tell us "no" that we didn't need to say anything to her mom about a positive attitude? I didn't care at that point. Those things could be explored later because they weren't going to make a whit of difference with this mom (or this type of mom).

Instead, I wanted to explore what was going on physically. Mom didn't want me to strip her again. She asked for a vag exam, but pushed me out after finding dilation quick and fast. She was continuing to dilate with no contractions.

And we didn't have the Hep lock in.

When we arrived, I had everything laid out and one midwife tried to get the IV going, but couldn't get a vein. After she tried twice, the other midwife tried and didn't get it either. Now, this mom was a champion sport in allowing herself to be poked so many times. The second midwife tried 3 times and couldn't get it. The OB nurse grandmother looked and wouldn't attempt a vein anywhere. We abandoned the IV plans. Red flag for me.

It was about 18 hours after her water broke when I started hints about going to the hospital. Her mother was dropping bombs whereas I was trickling droplets about it. By 20 hours, after another pow wow with the midwives, I really thought it was best if we go since she continued dilating... was a 5-6 at that point.

One midwife was missing and she had asked us to only call in an absolute emergency (she was in the northeast looking at fall leaves with her husband; her first vacation in years). The client said she wanted to know her opinion, so I called and left a message since she didn't answer. I went back in and said we might just have to make a decision without her.

The three midwives and I sat on the client's bed and talked with her, her husband, and her doula about the options ahead. If we had the IV in, it would be safer with how silent her labor was going. I was very concerned that if she kept dilating, that eventually, she would have a baby, yet also have a uterus that was in complete atony and she could bleed as we did bimanual compression, give IM meds while waiting the 3-5 min for them to kick in and allow EMS to arrive as she, once again, had a harrowing, naked experience in an ambulance and in the hospital. I felt controlled was a much better option. It just took her time to ponder the options herself.

What were those options?

* Stay at home and wait to go into transition (going into labor wasn't going to happen)

* Go to the hospital without a fever, without meconium, without contractions and have pitocin (we felt that, surely, she would have a whiff of pit and cough the baby out) and leave asap afterwards.

* Send us home and call us when labor kicked in (that wasn't remotely going to happen, but was certainly an option)

She loved her doctor, who, apparently, backs up another midwife in the community (whom I have never met), but he was away in Africa and she didn't want anyone else. I asked her to call his office and ask when he got back and they told her he'd been back for 10 days! They said he was on-call at the hospital (the term is Doc in the Box), so the client called L&D and found her beloved doctor.

I met this doc last time after her transport and he was very kind and loving. He never gave her a hard time about the home birth and, in fact, didn't even give her grief about wanting another homebirth this time! Something other docs, even supportive ones, would have had cows over.

The doc suggested she come on in, sniff the cork (of pitocin) and have her baby. We concurred.

While mom was making her decision, her mother came into the room and stood there. The client told her mom she was hearing about her options and the mom said, "you know your options already" and the client said, "without you. I want to decide without you" yet mom stood in the doorway as we sat in uncomfortable silence waiting for her to leave. She ended up stomping off and the husband closed the door gently behind her.

She had made her decision and once it was voiced, began gathering her things for the hospital -stopped at one point and cried. I pulled her into my arms and cried with her as we shared the disappointment for what she wanted so badly and what we had worked so hard to accomplish. I didn't make any comments about safety or this is for the best or we tried everything. I merely held her and cried with her as she mourned her last opportunity for a homebirth that was beautiful and gentle. (She would have no more children... it was already a surgically done deal.)

She finished getting ready and we packed my midwifery equipment up and got it into the car. (God, I love my organized birth kit! It set up and broke down in mere minutes!)

25 Hour Precipitous Delivery - Part 1

Yay! She had the baby. I'd been up since 5am and Athena was really pounding my head (but not quite as bad as when I almost called 911), so I left childbirth class early so I could go home and go to bed. On the way home, I called Sarah and I was hungry, so we were going to stop at Wendy's for a quick bite (she was on-duty).

She'd waited for me at the end of the ramp, but I headed to the next exit as she got onto the highway in front of me to do the same. She was further ahead and I couldn't see her, but I expected to at the light at the end of the ramp. When I didn't, I asked where she was and she told me as a red Izuzu came flying past me and the ran a way red light and continued speeding towards Sarah. I kinda gasped and screamed as I told her about the guy and said he was coming up behind her on her right.

And she got him.

laugh laugh

I went to Wendy's and sat in the car waiting for her while reading.

My client (J) called saying she'd either ruptured her membranes or was wetting her pants. I was on my way and called the other 2 midwives to alert them. My original back-up was still seeing fall leaves in the northeast.

Getting to her house, I gave her some nitrazine and she showed me it was, indeed, a deep blue color; membranes broken!

I called the other midwives who were hurrying over (remember, her last labor was half an hour... seconds after her membranes ruptured... and she'd hemorrhaged so badly she needed to be transported. I missed that birth, but made it for the hemorrhage and got her antecubetal [inside the elbow] vein to start the IV before the transport. Her Hgb 4 hours postpartum was an 8... transfusion material right there, but Hgb's go down over the first 48 hours before showing the true hemorrhage experience; she wasn't ever tested after the 8) and I began setting up.

Setting up for myself was relaxed and comfortable. I have been exhorted to set-up by other midwives when working with them, but for myself, it was gentle and easy. I'd already arranged my bags appropriately (although, rearranged them some after the experience of using my new organizational skills), so it wasn't so difficult getting things out and in their proper places.

We knew we were going to do an IV, so I pulled the equipment and supplies out for that and set them on the chair. The oxygen was on and readied, the birth equipment in my new carry-all was ready on top of the oxygen tank, the blankets and towels and washcloths with one hat were sandwiched between the heating pads on my NEW resuscitation board a client made for me last week (I love love love it, but the way... he made it with a handle cut into it and it is sturdy and holds all the equipment perfectly for the baby! I told him to come up with a price because other midwives are going to want one, too... it fits perfectly in a standard pillowcase. I have wanted one for years!), got the stuff out of her bins... Chux, peroxide, etc. and had things where they needed to be and removed things from the small room when they weren't going to be needed for awhile. I was pleased.

Sarah called in the meantime and asked where I was and when I told her that J was going to have her baby, she asked if she could bring me food. I told her sure! and then later realized she was in uniform and how humorous this could be.

We talked about crampiness and bloody show (there was none), that I didn't need to do an exam until she asked, but that I wanted to minimize them and she agreed. I'd taken vitals before even setting up and began charting the labor notes and forms that come with birthing (dates and times of significant events in labor); all was great.

Sarah arrived all bulky in her cop uniform bringing Wendy's. She sat at the kitchen counter waiting for the rest of the folks to arrive as I continued going back and forth setting up. Her mom came in breathless... is the baby here?!? why is the Sheriff here?! And we giggled, introducing Sarah as she sat eating her Wendy's. Friend after family member, the same scenario ocurred as J laughed about their nervousness when she was still walking around.

The first other midwife arrived, not nervous, knowing it was going to be Sarah and she laughed seeing her in her uniform as opposed to nice clothes at the office. She is SO imposing in that uniform!

The other midwife arrived and we began our sitting and talking that would continue through the night and into the next day.

Wednesday, September 29, 2004

VBAC Birth Story - 9/28/04

I rolled over in bed this morning (about half an hour ago; it's 4:25am right now) and felt my muscles tight. For a moment, I couldn't think of why. Oh, yeah! I helped a woman have a VBAC Tuesday morning!!!

What an AMAZING birth that was, too.

A woman with a baby almost 11 pounds last time... she'd gone 43 weeks and was induced with cytotec... pushed for several hours, and then had a cesarean, wanted a VBAC very badly this time. Not many of the docs would give her a chance; she found one.

When I met her, she was about 34 weeks pregnant (maybe a tad earlier)... she'd been sent to me from another doula who isn't taking clients anymore... and she came to one part of the childbirth class I teach with Konuwena at the office. She was delighted, but knew her husband would have hated it (too hippie for him). After the class, she and I talked a lot about her last birth, this pregnancy, and her wishes for this birth. In discussions, we talked diet. While she wasn't GDM last time, she ate tons of ice cream and dairy last time... and beef. I encouraged her to re-think that this time... to stop those high calorie, high hormone foods... and work at growing a smaller baby since it, most likely, WAS a baby that wouldn't fit through her pelvis (she hadn't been in bed at all during the previous labor).

I went and met her family and her husband and I got along nicely and I loved their son... what a cutie! We decided we were a good fit... what my role would be... how we would play this out, etc. It was a pretty typical sort of "birth plan," but I was mostly wanting to know how far she would go with a VBAC desire and how she would cope with another cesarean. She and her husband were a great pair of folks who were open to anything that would happen... not intensely married to the VBAC and wouldn't be depressed, just mildly disappointed, if another cesarean became necessary. These types of people are the easiest to work with sometimes since small nuances of change don't topple the entire pyramid of hopes and dreams. I find that those who are brick walls of hopes and dreams (the absolute To Think Is To Create people) create much more sadness and disappointment in their experiences than those who are able to "go with the flow" of labor which is, as many know, a fluid rather than a solid.

My cell phone had died, but Sarah and I went and got a new one Monday night... a new bright red one to go with my bright red DayTimer to go with my red Explorer... but most people didn't know I had a phone again, so I woke up at 7am and found an email from this client that she had been up since 5am or so with some contractions; please call when I got the note. I called and she was talking through contractions and said I didn't need to come over yet, so I did more email (the computer was still down at work, so I had PLENTY to catch up on) and got a call again at 8:30am from her husband. I always know when the man calls, it is time to head out. He said her water had just broken (it was clear). Asking what the doc had suggested (knowing), he said he couldn't remember, so I said he should call and ask and I quickly got ready and was walking out the door when he called back and said, "Meet ya at the hospital!"

I got to the hospital about 40 minutes later (traffic!) and walked in to find her 10cm! She was 9cm in triage, but progressed fast... feeling some small urges to push, but not pushing terribly hard as she waited for the doc.

Once he came in, he suggested she kneel (she has knee issues, so squatting wasn't good for her) and I parked myself at the end of the bed as she kneeled onto my body... I held her up as she leaned and pushed with each contraction... just when she needed to. They were short, but she pushed (not as effective as I would have liked, but I encouraged her pushing when she did) and she was so tired already. I smiled and reminded her how women feel this right before their babies come... that she was right on schedule. We did a few of these kinds of contractions and her husband, who is very tall, moved into my spot and I asked for the squat bar.

The squat bar was brought in and she used that instead of her husband or I, but I squatted in front of her, on the floor, looking up at her as she pushed; we pushed together. It was great. SHE was great! We played with pillows so she could rest inbetween contractions... her leaning down on her elbows sometimes on the bed, other times, her head on a pillow on the bar... each time kneeling/pushing/opening with contractions that were petering out... spacing out and shortening as time passed.

The baby, also, was having some decels after her contractions... not the most fabulous to hear. We had her breathe deeply with each resolution of contractions and the baby liked that lots.

Once, she said she couldn't do much more... that she wanted to have surgery. I asked her if she wanted me to remind her of what she told me she felt after the last birth... the pain, the sadness, the frustration... and she said she did, so I did. Another time, she said, "I can't do much more" and I said she didn't have to, that she was almost done. Then, at one point, she looked me in the eye and said, "I can't do anymore." I asked her what I could do to support her... did she want me to keep encouraging her, because I could... or did she want me to support her choice for a cesarean. She said, "I want a cesarean."

I told the nurse who said she had to get papers, but put the IV tubing onto the Hep Lock she had on her arm before leaving the room. Mom wanted to lie down, the nurse was inputting stuff into the computer, and said, "sure!" so I helped her lay down on her left side. Immediately, the baby's heart rate began lowering... I flipped her to her right side and the heart rate climbed slowly, but stayed steady. Her contractions had nearly stopped and she laid there as I talked and explained about people coming in, having the spinal, the Bicitra (the stuff you drink before surgery that neutrilizes stomach acids), etc. and the nurse went to find the doctor.

The baby's heart rate continued doing funky things and mom said she had been hearing it and that scared her, prompting her to want the cesarean sooner than later. I told her that she was making the perfect decision for her and her baby and I smoothed her hair as we waited.

The doc came in and said he wanted to check one more time and gloved and did an exam and asked her to push. She said she couldn't and he said, "PUSH!" and she did... and that baby came DOWN onto the perineum! WheeeeeeHA! we were NOT heading to the OR!

The doc gloved again (wrong size gloves) and asked her to wait as we watched the head beyond a crown. I encouraged mom to touch and she was awed by what she felt. I asked the doc if I should go get a nurse for him and he said, "uh, sure" so I stepped beyond the curtain and told the nurse... baby's coming!

Back in, the doc got the right sized gloves on and the baby was being born... up to the arms coming out, the doc asked her (told her) to reach down and take her baby and she reached down and grabbed her baby and pulled him out of her body. It was magnificent!!!

She exulted: I DID IT!!!!!!!!

And we all were SO thrilled! She started crying, her mother (who'd never seen a baby as this mom was adopted) was crying in the chair across the room (she came in for the birth only), and her husband was so happy! It was the coolest thing! I wish I'd had a camera to take a picture of her scar with that baby coming out of her; it was PERFECT!

I was so proud of the doctor for continuing to believe in her. I was SO proud of the mom for that magnificent push she gave the doctor! I'd suggested a number of times that perhaps someone's fingers inside might help her focus where to push (it can also help the urge in a time of contractions leveling out), but she didn't want that, so I didn't do it; it turned out that was what she needed!

This baby was nearly 2 pounds lighter than her last one. The baby was born at 39 weeks and was bribed to come out with "you can have ice cream when you come out." I laughed!

How wonderful... what a great outcome.We are all sore. We are all jubilant!

Afterthoughts:

The baby had some facial bruising indicative of a posterior rotating baby. Near the end, she complained of hip pain, which would be the baby rotating through. I believe that when she was on hands and knees, the baby wasn't as able to rotate, but when she laid on her side and then flipped to the other side, that baby floated around, too. I firmly believe if she had stayed just upright, unless she could truly squat, the baby might have stayed in a rotating (acynclitic) position.

At one point, the nurse asked if I was an L&D nurse because when the heart rate wasn't able to be heard, I would hold the monitor on her belly so we could hear. And various other reasons, I am sure (seeing that an internal monitor would be far easier on the mom to listen to the baby and suggesting it as an option... by asking if that was something she didn't want first and she said she didn't care, so we talked about it for a few moments and she said, "do it so you all don't have to keep pushing on my stomach," so an internal was put in on the baby)... knowing where the chux were, the washcloths, etc. I didn't get squeamish about watching for the head or changing chux. I told her that, no, I was a midwife, but that I had tons of experience in the hospital. She said I was a great doula... much better than most she ever saw. I thanked her kindly.

Later, we talked a little about doulas and how they get more married to birth plans than some couples do and she said she sees it all the time. I told her that I was there for the mama... to help her feel happy about every choice that she makes, even if it deviates from that Perfect Birth birth plan she'd created in her mind. The nurse thanked me for my realistic attitude and I told her it came from 22 years of watching birth and life in all settings and my belief in birth.

As I walked out when I was leaving, she took my hand and said I really was the best doula she had ever seen here in San Diego... thanked me lots for being there, that I had made her job easier by far... and that I was just great with the couple. The couple had already hugged me warmly (as did the new grandma) and told me I was GREAT!

I was high as I got in the car to head to work. A great birth. What a "job" I have, eh?

Monday, September 20, 2004

Sukkah Birth (last night)

I was asked at the last minute to assist Gerri... love working with her, she and I being nice and hands off. She is the midwife that was at Donna's birth, too.

The woman's water broke at 9pm on the 18th, but no labor for about 12 hours. When Gerri went to check on her, she was still in very early labor, so she and her daughter (a new doula) came to the Reclaiming Birth Conference meeting we were having at Ama Mama on Sunday. Donna was coming to the meeting to help with Registration, so it was vital to have the meeting.

I'd been awakened by Gerri's daughter at 6am telling me to come now, but then, stepping into the car, Gerri said she was still really early.

The Con meeting was at noon.We had our long meeting (I talked to a couple of the women until 5pm!) and then napped until I was awakened at 6:15pm by my pager telling me to come up the mountain since it was still kind of light.

I woke up, gathered all my stuff together (I have been organizing my birth kit for a couple of days), and headed out. I wasn't going to make it before dark.

As I headed east and then north and then up this mountain, I saw what Gerri had warned me about; the cliffs that fell quickly if I took my eyes off the road for a second! I followed the directions very slowly, brights on, paper in hand and found my way to the steep hill upward that would then level off at their home that was in the midst of being constructed upon. If I gunned it too much, I would head either off the cliff on the left side of the driveway or into the embankment they were building to protect against mudslides in the rainy (*cough*) season. I didn't do either, so I must have found the correct gas pedal pressure.

Mom was in the hot tub (Aqua Doula, actually) and I quietly asked Gerri what she needed me to do; she said nothing, so I acclimated myself to Gerri's oxygen tanks (location), the med kit (by the O2 tanks), and other supplies. Gerri's daughter was her fetcher, so I grabbed my organizing Bible and sat in the livingroom reading. It was freezing outside! (60 degrees according to my car thermometer.)

I could hear mom's beautiful labor song... moaning, sometimes squeeking, and her 4 year old son (who is still nursing) talking to his mom and dad, being tended to by a beautiful teenager who had seen other births (her mama had had a baby with the midwife here in town who'd spent time in prison).

This mom loved the hot water. Periodically, I would open the door for the doula/friend as she carried giant spaghetti pots of boiling water to the tub and gently immersed the hot water into the tub with a coffee cup.

I love being in other people's homes. It is so cool to see how people live. I would say these were homesteaders, except for glaring paradoxes: only wooden toys in the house, but a state-of-the-art computer system; hundreds of books, many on simplifying, but a large flat screen tv in the living room; dozens of aromatherapy bottles, but an indoor toilet; only organic food in the house, but 2 cars of theirs in the driveway. So interesting!

Gerri asked me once to come and listen to heart tones as she charted, so I leaned into the tub to listen (after asking permission) and the baby sounded wonderful! Dad had gotten in the water with mom by now, too.

I was reading again and could hear her beginning grunts through her song and Gerri's daughter came in and told me she was starting to push. I smiled and said I was listening and thank you for letting me know, that I was right there when her mama needed me.

The contractions spaced out as second stage contractions are wont to do and as soon as she started pushing from the beginning of a contraction, I wandered outside into the cold night. It had started sprinkling.

The hot tub was tucked inside a corn stalk teepee sort of creation... like a sukkah Jews make during Sukkot (http://www.torah.org/learning/yomtov/sukkos/succospictures.html), but with much less substance. The sky was easily seen through the top and the rain sprinkled down on our heads gently. Stars peeked out when the clouds passed by. I don't remember the moon at all, but know it isn't full (despite it bringing 3 babies in our practice within 12 hours of each other!).

Mom could feel the baby moving down and she was on her hands and knees... a very small woman... she knelt her knees on her husband's thighs and she clung herself around his neck... nuzzling him as his face was pure bliss at his wife's sheer determination and focus at birthing their baby. The 4 year old was asked to come into the water by mom and he jumped in, sweat shirt and all. I watched quietly, finding myself pulling back against the teepee to offer them privacy and room; Gerri did the same.

We could see the head coming with the tiny flashlight, otherwise, it was dark except for the light from the living room window that was shaded. I took off my sweater and Gerri asked if I wanted to bring the O2 over (it was behind the teepee, behind me) and I said I could grab it fast, but I didn't think I would need it. (I didn't say it in that many words and it was said almost silently.)

Gerri asked mom to feel her baby and she kept shaking her head "no" into her man's shoulders; I could see her biting him. I touched dad's hand gently and reminded him that he could touch his child's head if he wanted and his face lit up even more as his left hand found his baby's head and he told his wife how wonderful it was that the baby was so close!

There was no talking between contractions and the closer the birth was, even the young child was more quiet. We couldn't hear cars, birds, bugs, or anything else but the birthsong. And it was perfect.

Mom's voice arched and we watched the head slide out easily... a baby with its eyes closed, facing up (mom was still on hands and knees) and the sibling came close and was hesitant to touch even as we whispered that it was okay to touch softly (so's not to stimulate the baby).

Instead, we watched with amazement and joy and waited for another contraction. As it began to build, mom reminded her son that he was going to catch the baby and, instantly and in slow motion, two arms popped out at the same time! All that was outside of her body was a head, shoulders, and two arms... reaching... and the baby's brother reached over and took the baby's arms in his hands and we encouraged mom to lean back so the baby could leave her body and she would be able to hold her baby... and simultaneously, she leaned, the son helped the new baby out (Gerri was close, but not touching) and right onto his mama's tummy and they all laid in dad's lap/chest/heart. I couldn't stop smiling!

I watched to make sure the baby was doing well. Her eyes were open, but she didn't make any noises for about a minute or so, but she was pink, her eyes open, and her cord, we could see (we didn't touch) was pulsing hard. Once she began breathing, she made one or two little wahhh's and then she just sat there and looked around. We didn't know she was a she for a few minutes, but everyone looked and verified that the new baby was, indeed, a girl.

The new baby closed her eyes after a couple of minutes and mom was worried, so I asked if I could feel her heart rate and mom said, "anything you need to do, just do it!" but it was important for me to ask anyway. (She doesn't know; we do.) I felt her chest (no gloves) and her heart was at least 140-150 and I put mom's and dad's fingers on her chest so they could feel and they were reassured... much better than if I told them blah blah blah... it is always better to feel than hear, don't you think?

We dried the baby's head off and put her warm hat on. No towels or blankets since they wick wet to the baby and make them even colder... better to keep them submerged. I took that coffee cup from earlier and gently poured water over the baby as mom, dad, and older sibling talked and spent time together.

About 15 minutes after the birth, mom wanted to move to the couch because she was getting cold. In the strategy (discussion) of moving a mom with a placenta inside that has its cord still attached to the baby that mom is holding and out of an Aqua Doula (that is pretty darn tall, especially since she was short), we choreographed it well and there was zero bleeding so no need for the Chux Holder between her legs either. There was one person on each side, one behind, me in front (hands near the baby) and we 10-legged walked into the house, putting our feet into the water bucket before entering to get the sand off.

Mom sat on the couch and began nursing. In time, she spoke of contractions and her back hurting (tailbone), but Gerri thought it might be from the birth (rotation). I have heard many women describe that sensation when the placenta is sitting in the vaginal vault, but not yet out. About 40 min after the birth, Gerri suggested we move her and I suggested a supported squat. Great idea, Gerri said, and we did just that... and the placenta plopped right out. The backache stopped immediately. smile

There was less than 200cc blood from this woman. Her uterus was tight and hard and 2 fingerbreadths below her umbilicus already! I wasn't needed anymore.

The baby was nursing great, had already had her first poops, and the family was enamored with their daughter... 7 pounds even, Gerri tells me today.

This beautiful baby was born 24 hours and 1 minute after mom's water broke.

Her middle name is Summer... and, what a beautiful birth to attend on these waning days of summer.

I am honored and blessed.

Tuesday, August 31, 2004

Assisting the Midwife

I was invited to assist at the last minute because the other assistant was dis-invited. I'd expected to attend this client's last birth, but didn't go for whatever reason, and was surprised to be invited this time, but glad.

Mom wanted the baby on her husband's birthday... so badly that she had acupuncture, was stripped more than once, and prayed hard to deliver on his birthday. On that day, she was in early labor... 3-4 cm dilated and contracting regularly. Once midnight passed, however, contractions stopped and she breathed a huge sigh of relief that the pressure was off.

5 days later, she began labor in earnest.

Third baby, last labor was 4 hours long. I was called to come at about 11pm and flew the 30 miles in 20 minutes (I swear I didn't go over 90 mph!). Once there, mom was chatting, moaning with contractions (that were very short!), and wandering around the neighborhood. I slept on the couch as best as I could.

Hours later, mom wanted her water broken. She said that last time they broke her water and the baby came. She wanted the same trick this time. The midwife came and asked me what I thought. (I was downstairs. The client was very specific in asking me to allow her midwife to speak and Be the midwife; I honored that implicitely.) I asked the midwife if she might delay the ROM in the hopes that the baby would come first, so she bought the bag another 90 minutes or so before the mom demanded the membranes be ruptured.

Interesting aside: Does doing what the mom wants include interventions I don't feel are necessary?

The midwife broke the water... nice and clear, but the baby's heart rate went down fast and we moved her to her side and it recovered. She got up and went into the pool... very discouraged that this birth was so much longer than her last one... even longer than the first.

There are tales of third babies and boys doing what they want to do... patterns be damned. This was a third baby AND a boy (she knew already), so we just shrugged and told her she was doing great and encouraged her to hang in there.

Earlier, she told us that she had been so very tired with the girls' births... this one, she was awake! During the time after the ROM, she told us, over and over how tired she was. I reminded her how she said that about her last births and now she was there... at that place of close-to-delivery; it seemed to help.

Her hips were hurting. With nearly every contraction, she moaned about her hips and how if that single pain would just go away, it would all be fine. After the birth, I told her that every woman had that one thing that, if it went away, the birth would have been just fine. For some, it is hips; others, their back... still others, their belly... others, the nausea and vomiting. Every woman seems to have at least one major complaint about their labor that, if it would just go away, the labor would be tolerable. I smiled knowing my own complaints.

I spoke as little as possible, but whispered a lot to the midwife because she kept doing vaginal exams. The mom had a cervical lip and the midwife tried to push it out of the way. I cringed. Once the mom had her membranes ruptured and moved off the bed, she got into the pool on hands and knees and wanted to PUSH. The midwife wanted to check "just in case" and I whispered to her that she didn't need to... if the mom wanted to, let her... if it hurt, she would stop. She didn't quite take her hand out of her vagina, but she pulled out some and when the mom had a contraction, she pushed fiercely! The midwife asked her (hesitantly) if it hurt and she howled NO! and then the head was on the perineum.

Once the head was born, the mom was resting, but the midwife got nervous and began pulling on the head, well, it is traction (lifting and lowering the head... most people describe it as pulling, but there is more to the motion than that) anyway... I told her it was fine... she could wait for a contraction, but she wouldn't. She instructed the mom to PUSH as if there was a problem (there wasn't). The baby was meowing... his lips were pursing and opening... so lovely! She had just begun a contraction as she was pushing to the midwife's exhortations and out came his body to his waist. The midwife asked mom to lean back and pushed the baby through her legs and mom grabbed the baby the rest of the way out of her own body. Beautiful!

I waited a few moments (but know that this midwife was trained to listen fast for heart rate and respirations) and then gently listened as he took his first great breath. He was quiet... and perfect.

Immediately, the mom asks if she is peeing or something and we look down and the pool is filling with blood... like ink gooshing into clear water... the midwife wanted her out of the water. We lifted her and got her onto the makeshift space on the floor lying against the most gigantic bean bag chair I have ever seen and blood continued to flow. The placenta was right there, so the midwife delivered it (Duncan) and my hand went right onto her boggy uterus.

With every massage, blood squirted out... over and over, trying to get the uterus to do its job. We gave her oxygen first because she felt funky and was getting glassy-eyed... then a homeopathic I can't remember right this second... and then, finally, a shot of pitocin that we had drawn up because she'd needed 2 last time. The pit quelled the bleeding after a few moments. I gently touched her fundus to make sure things were cool and only once did I have to rub up another contraction for her because then this cute boy latched on and didn't let go!

We cleaned up and the midwife thanked me lots for sharing my patience and belief that we don't have to make sure the cervix is out of the way to birth the baby. It was funny. I felt SO relaxed... even during the bleeding... even when he hadn't taken a breath... that I figured out that it was the midwives around me in many instances that had made me nervous and act in ways I didn't believe I should... not necessarily my own fear. I loved that realization!

This was a quiet, gentle, loving birth. There were ways I wouldn't have acted, but really, it wasn't my client and the client chose the other midwife. I was there to serve the mother AND the midwife.

I feel good that I did both.


Friday, August 20, 2004

Humility?

Why isn't it important for some to learn humility in pregnancy?

I heard a midwife once say, as she recovered from her 50+ hour labor and cesarean, "I never had any idea. I thought I knew birth. I had no idea what giving birth was about until this experience." This was a woman who had been a nanny, a doula, and a midwife for years.

Why was it that, during her pregnancy, when her midwives (not me) tried to speak to her about her I Will Never Go To The Hospital Unless I Am Dying or The Baby Is Dying attitude, didn't she listen... couldn't she listen? Isn't it painfully obvious that the more we resist something, the harder God/the Universe is going to shove it into our faces? Isn't surrender our lesson on so many levels? So much of the time?

By her own admission, she said she didn't even go to the Cesarean Place in her preparation; that just wasn't going to happen to her. She said until the second day of labor, she just couldn't even think about the hospital except for it being I AM NOT GOING THERE.

Then, as transport became obvious, cesarean thoughts were still non-existent.

Midwives are not immune to delusional thoughts of perfection any more than a first time mom who has never seen birth... and what birth can do as it unfolds... even without your help (especially without your help!).

She didn't even consider a cesarean for many hours with her cervix unchanged. Peace decended once the decision was made; she was going to meet her baby. Finally.

Nursing was a struggle and included formula to quell the screaming cries of the baby (I offered breast milk from donors), many pain meds, a uterine infection, incredible incisional pain, and the enormous mourning of the Birth Dream she had had her entire life. All things that were a Never Me belief in her world.

Never, ever say Never.

She tells the story that she is nothing like the midwife she was before her birth story. While she still feels that women can be fantastic midwives who haven't had children (as I do), she now knows, on a totally different level, the amount mothers are willing to sacrifice for our children... sometimes just to be born.

We have spoken about understanding why women would choose an epidural, why women would choose hospital births, how some women truly are in excruciating pain even if they have Hypnobirthed, Meditated, Yoga'd, Prayed throughout their pregnancies and lives... readying emotionally, physically, spiritually, intellectually... for the birth before them. UCers are wont to say that it is a mental thing, that pain crap. I sit quietly and shake my head and pray that they never experience what I have seen some of the most Holy Women on the earth experience as far as pain in birth goes.

If'n yer baby wants you to scream in pain, yer gonna do it... no matter how evolved you think you are.

However, my friend... my midwife-friend... she says her midwifery will never be the same. And neither is mine.

Tuesday, August 17, 2004

(Not) Love at First Sight

All these women over the years who hide their shame... I hear it over and over during subsequent pregnancies...

whispering

I didn't love my baby at first. I hear you, that is pretty common. No, you don't understand. I didn't even like him at all! It took days (weeks/months) to actually believe he was the same thing that had been inside me.

Was it:

the epidural?
the morphine?
the hospital?
the cesarean?
the doctor?
the forceps?
the vacuum?
the fight with my spouse?
the crappy babyhood I had?
the general anesthesia?
the exhaustion?
the surreal-ness of it all?
the real-ness of it all?
the fact that I wasn't ready to be a mom?
that I was a teen mom?
that I was an older mom?
that I was a single mom?

and the list is endless.

I think that those of us who see with our eyes tend to react differently than the blind women I have seen. Blind women (and I have only been with a couple in all these years, but I have talked to other midwives and doulas about this) tend to smell and feel... it is just different for those of us who use our eyes... our culture is just so... visual!

But, what of those of us who have reactions that have nothing to do with looks? The indifference after a long labor and/or complicated birth? What would happen in the wild? I believe the midwife would be the one to assist that new mama... holding the new baby to mom's breast... kicking in some hormones that help with the "bonding" stuff. I don't believe many babies in the wild born to exhausted moms were just left to fend for themselves as mom recovered.

Why does this happen? I wholeheartedly believe we are biochemical beings as much as Spiritual Beings. Low glucoses, long labors, quick labors, being denied food and drink for many hours, medications, stress, immobility, fear... all those and more all combine for a terrific combination that can really do a number on the biochemistry of a person's body! Add to that being cut open, having your child taken out, your guts rearranged, sewn up, more meds pumped in... all of those are major reasons why someone might not Be There for their child the way they had dreamt it would be.

Unfolding.

Unfolding is a lesson I have shared several times this week.

I know many people who watch movies and within 5 minutes have the entire ending in their expectation. I hate watching movies with these people IF they speak about it outloud. Sarah is forever second-guessing what people might do (could be a good cop trait, however)... trying to figure out why Aimee does this or the other thing... how come Tristan doesn't do such and such.

I am not like that. I learned a LONG time ago to allow things to unfold. I learned to not anticipate in movies... that way I was rarely disappointed. I never anticipate gifts, letters, cards, or thank-you's; therefore, they are always a delightful surprise!

In birth, as a midwife, if I have expectations of how someone will do/react to something, I am not only setting myself up for disappointment, but also setting HER up for failure. It doesn't mean I don't anticipate issues... shoulder dystocia, hemorrhage, etc. It doesn't mean I am not ready to resuscitate at a second's notice. It just means that I allow women to unfold in their births.

The biggest issue I have with childbirth classes is the Visualizing the Perfect Birth exercise... IF it is done without discussions of how even the most unpredictable birth can be considered Perfect (even with death). It is all fabulous to meditate and create, over and over, your birth. I absolutely believe in playing out how things will go. Shoot, I did that when I had the lumbar puncture and it did go as I rehearsed it! But, contingencies must be addressed or the class is failing the "student." Miserably.

No one (most no one) talks about the feelings that can appear (or NOT appear!) after birth. Who wants to hear that women hate their children or are indifferent or want them to go be adopted? Pregnant women who haven't experienced such intensity would/could judge harshly and the I Would NEVER Do That fall out of their mouths as if they were defending their very right to be a parent. I would say that at least a quarter of the women I have spoken with in these 20+ years have had this experience of Disbelief in Emotional Reactions after their birth. The entire gamut represented.

Gerber ads, formula ads, marketing, advertising, La Leche League pamphlets, magazines, etc. all push, Push, PUSH women to believe they will fall instantly in love with their newborn. Soft focus lenses and spaced out close-eyed stares from mother to infant... it all looks so good you could lap it up with a spoon.

A birth story unto itself, but one of the women I was second assist for labored for 20+ hours at home, pushed for 3 hours at home, another 2 at the hospital, a vacuum attempt (x3), the failed placement (x3) of an epidural THEN a spinal try, and then the baby freaking, the mom being put under general anesthesia and her baby born by cesarean. She didn't see her baby for over 2 hours, but dad held him and we all loved him lots.

The baby is almost 2 now and mom is still so freaked out at how she fucked up this kid's first hours of life on the earth. She has rebirthed with the child, has had cranio-sacral, homeopathy, therapy, medication, massage, and a dozen other modalities all trying to reconcile her "failure" as a mother to be there to bond with her child. No amount of words can soothe her pain; believe me, I have tried. So I listen, over and over, to her sadness... and I pray she gets unstuck and doesn't treat this child as The Second Coming. Apparently, sometimes, stuck feels better.

I have had numerous discussions with moms after we resuscitate newborns or after the baby was yanked out as it was dying inside mom and was worked on, removed from sight, and worked on more... or babies that are poked and prodded and have gadgets holding their bodies together... or babies who have their spine closed at 2 hours postpartum... or babies who have heart surgery at 1 hour postpartum, never having seen mom or dad... or babies who have their intestines pushed back inside and endure several surgeries to close their guts...

what of all these babies and their psyches?

I know many of these children as infants, children, teens, and now adults... and they are FINE.

It doesn't mean we don't WORK to have peaceful birth. It doesn't mean we ignore their feelings and sensitivities and indiscriminately screw monitor leads into their heads or spank their butts or speak evil of them.

It just means that when we HAVE to, (like my question to Donna about her calling Landen's birth her Perfect Birth... if I'd have had to give her pit or help Landen breathe, would it still have been perfect? Donna says YES because it would have been needed to sustain life), for goodness' sake, we are resilient beings! Our minds work through infinite crisises in our lives... death, pain, moving, divorce, separation from parents, sleeping alone for the first time... the list, as we know, is endless! Perhaps those of us with trauma (and I count myself since Meggie needed to be resuscitated at birth) have assisted our children in a life lesson that might aid them forevermore. Perhaps they CHOSE us so we could give them a part of their walk earlier than later... so they could be strong for something 50 years from their births.

Maybe I am just justifying.

Maybe I work too hard to help women let go of guilt. There is PLENTY to feel guilty about later as they get older. Believe me. It just starts around birth-time. It grows with every passing year.

I believe the true issue is if there is a disconnect with the child after time has passed. Some women do have connection issues (usually surrounding childhood abuse or drug/alcohol issues) and need help learning how to mother/parent. For some, it might be true postpartum depression. These are different than the transient, "Who the hell are you?" that so many women feel.

I hope this helps some. While I really do struggle with the phrase You are not alone because I feel it discounts feelings, I think that if women heard these stories pre-pregnancy and during their pregnancy, it might help women feel less alone.

And who wants to feel alone when we are scared?

Not I.

Thursday, August 12, 2004

Births in the Caul

I went a long, long time before ever seeing a baby born in the caul (inside the amniotic sac). In hospitals, the membranes are ruptured (broken) somewhere along the way in every birth I have been to. Even in birth centers, Artificial Rupture of Membranes (AROM) is absolutely commonplace. At Casa, the students need to learn to rupture the membranes (and yes, "rupture" isn't the prettiest word... some say "release" which IS nicer, but absolutely contraindicated in AROM), so we routinely did so... sometimes with our fingers, fingernails (inside gloves), or with the AmniHook... a long crochet-needle looking thing with a beak on the end that snags the bag and breaks it, releasing the water.

(Rupturing membranes is a blogspot unto itself... another day... remind me!)

Then, a midwife at Casa thought it would be a grand idea to see how many babies we could have born in the caul and the game was on. I'd heard about an OB that was so disgusted with AROM that he offered a $50 bounty for every caul birth and shelled out thousands before calling the game... proving that it is possible and isn't dangerous and not AROMing did not slow labors down, but, in fact, helped women cope better.

The first caul birth I saw was so cool! I was doula-ing at UCSD at the Birth Center (on the 4th floor) and the CNM was terrific in wanting to leave things alone. As the baby was being born, it dawned on me that the mom's membranes were still intact; soooo cool! The baby was born with a tight sac on the face and shoulders before the midwife used forceps to break and lift the bag off the baby's face before the first breath.

Another I saw was at Casa. I spent a lot of time there in 2002... about 9 months total that year. There were times I was so exhausted, I could not get up to witness births. My first trip there in 1993, I went to every single birth I possibly could... 90 in 3 months, catching 30 myself. These long months of "getting numbers" in order to sit for the California exam, were exhausting and sometimes I just ignored the "Birth in the Bear Room!" call over the intercom.

But, when cool things happened, I was asked to come anyway to photograph. I always made sure the mom was asked if it was okay before I was awakened because I had shown up once with a camera and a mom was horrified. I left with camera in tow.

So, there was a birth happening and the membranes were still intact and someone knew the birth would be something to see. Groggily, I grabbed my camera and went to the birth, watching and taking picture after picture of the most amazing sight; the sac began protruding, water filling up the sac gradually... a slow, s l o w birth where the sac came long before a head did. I began seeing hair floating in the water behind the amazing amnion and chorion... flecks of vernix swirling around as the head began being able to be seen.

I have a picture here:

http://www.picturetrail.com/gallery/view?p=999&gid=4228092&uid=631889&members=1&galleryPassword=emTzTTD1RyAd2&

As the baby was born, the bag broke and water spilled onto the bed and the midwife lifted the bag over his face. I loved capturing it on film!

One birth here in San Diego, I was the first assist and was behind a kneeling mama with the midwife. It was cave-dark and we began watching the membranes bulge the perineum. This midwife had not seen a birth in the caul, so I gave whispering instructions about how to manage it so the baby can breathe.

When the head is born, it is important to watch for breathing motions because if those happen, it is important to remove the sac from the face. If s/he isn't making a motion to breathe, allowing the body to flow out inside the caul is perfectly fine. Once the chest is born, removing the sac is imperative since the first inhalation often comes from the release of chest compression from the vagina. I explained about lifting from the chin upwards because two midwives I know had babies aspirate their amniotic sac because it was pulled downwards from forehead to chin and as it came down, the baby inhaled. (Remember how I said we are a product of our experiences? This is a lesson I learned without it happening to me directly!)

So, as she is pushing, we see a darkness in the forward moving sac... vernix? meconium? I had the third assist grab the flashlight and we peered into the sac. Inbetween pushes, the floating stuff settled to the bottom of the "bag" and we had to wait for the next contraction to stir things up again. It was wild to watch! Once the contraction began, we saw that it was, indeed, meconium and pretty darn thick, too. The midwife asked mom's permission to break the water right before the head was born so she could suction with a DeLee (something we don't do anymore) and mama said, "okay," so we did. I often wonder what that would have looked like to let the baby keep coming in the floating mec pool. Probably safer.

As this baby came out, even though the midwife had broken the bag, the amniotic sac was still covering the baby's face. She, however, did not see it! I showed her how it looked like cellophane and that anytime there are late ROM, to check closely to get the face cleared. She was wide-eyed as I pulled a completely covering film of amniotic sac off the baby's face... chin to forehead. The baby inhaled as I lifted.

It is said that babies born in the caul are special or gifted. Various traditions around the world say that the baby will never drown... that the baby will be a midwife... that the baby will have a second sight (a view into the Other Side or psychic powers). I find, as time goes by, that I touch membranes less and less. I believe they are there for a reason... will break when ready... and serve a purpose we might never know.

But, can I tell you quick about how the gift of an amniotic sac helped my partner Sarah after her eye cancer surgery?

You see, in hospitals, placentas (with their amniotic sacs) are "donated" by the women. Cosmetic companies and, ever increasingly, medical supply places buy them for a variety of reasons. Many of us feel women should be paid for their placentas, but the hospital considers them donations (tax deductible? I don't think so). Hardly anyone knows about this donation, either.

So, many parts to the story that I will eventually blog, but Sarah had to have some lymphoma cut out of her eyeball (in the white, not over the part where she sees) and the surgeons were discussing the surgery and all that it entailed. They told us that they would graft it (cover it, actually) with one of two things: the foreskin of a circumcised penis or the amnion of an amniotic sac. I could NOT believe, first of all, that they really sold and USED foreskins from babies. She said she could not have that in her eye because then she would be cock-eyed. They didn't laugh. Really, truly, she told them ethically she could not do that. They said fine, amnion it is (there are two pieces to the amniotic sac... the amnion and the chorion... each has its role in the baby department and can be separated, but is very much like sticky cellophane pulling them apart). They were equally unamused when I offered to bring in swatches of amniotic sacs to see which one matched her eye color best. We thought it was hysterical.

After her surgery, we could see this precious gift from an unknowing mom and baby... a centimeter-wide circle that was covering where the cancer had been dug out and sutured with 40 stitches... teeny tiny stitches that she blinked on for several weeks. We both thought of and sent prayers of thanks to this mom and baby that they would give this gift so Sarah's eyeball cells could regrow together, using the amnion as a scaffold to cross and join together as it healed.

Within weeks, the amnion was covered and we couldn't see it anymore. Her body had absorbed it... made it her own.

What a miracle our bodies are!

Tristan's Birth Story

Tristan Ian; born October 20, 1982; Orlando, Florida
9 pounds 4 ounces, 21 inches long


I was unmarried and 20 years old, but hanging out with the kids' dad.

When I found out what I was pregnant (my boyfriend [bf] and I used three-way calling to hear the results from the clinic), my mom cried and asked me to schedule an abortion. I declined.

My bf came over and brought me a box of Chips Ahoy and a gallon of milk; I polished them off in no time. I had just lost 70 pounds riding my bike to Subway (where we worked) and starving... I wasn't going to starve anymore.

I gained so much weight during the pregnancy, the doctors kept telling me how horrible my birth was going to be. I was on Medicaid and about 6 months along, I learned that the hospital where I was going to deliver didn't allow the fathers in unless you were married... even if they had a certificate from a childbirth class. I changed hospitals. (Later I learned that the first hospital also still used scopolamine in labor! an amnesiac that fell out of favor in th 70's.)

Florida Hospital was much kinder and my former hubby and his mom worked there (in the kitchen) and everyone knew them, so it was really nice. They always gave me cookies. To this day, Florida Hospital (a 7th Day Adventist Hospital) still makes the best peanut butter cookies on the planet.

I was scheduled for a sono... very unusual at that time... because I was so big. When I saw the sono, I was horrified that my child was deformed, yet no one said anything! No phone calls later telling me to come in to discuss things... no "I'm so sorry, Miss Herrera." Nothing. I cried the entire rest of the pregnancy. Even if no one else saw it, I saw my kid's hand... all balled into a claw fist. I knew that alcohol and valium I took that one time deformed my kid. I was filled with guilt and remorse.

Not enough to quit smoking, however. I smoked throughout the pregnancy. I endured nasty looks, but it was nothing that a smoking pregnant woman would deal with today.

EPCOT at Disney World opened October 1, 1982, but mom got us tickets to a cast preview and we went the last day of September. I was so swollen and exhausted, I couldn't walk, so my bf got me a wheelchair and pushed me around. Those pictures are so sad! My eyes, nearly swollen shut... my ankles the size of someone else's thighs... so, so much water. Still, I smoked. I cut out salt like I was told to do... knew nothing of adding protein (but doubt I would have listened anyway).

On October 18, we went to a school presentation thingie and when we came home (bf and I were living with his parents by then... he was a mere 17!), I sat on the bed and kind of heard a pop, but no leaking. We had finished childbirth classes a few weeks earlier and they suggested lying down to see if moving the head a little would let some water out if the membranes had ruptured. Lying down, sitting up, lying down again... nothing. We went to bed.

Childbirth class was amazing! 100 couples in the auditorium of Florida Hospital South. All of us with pillows and the women with eager faces... the guys, not happy to be there so late on a school night. A Lamaze teacher (RN) showed us all the ways to be great patients on L&D. She let us know when to ask for meds (epidurals were not an option back then), ways to roll over with monitors on, making sure we had plenty of ice chips... and bring your socks 'cuz it can get cold up there! When you have your episiotomy, you will have a shot of novacaine (they still used that then! it's lidocaine, now). You will have 30 minutes of Bonding Time if you and the baby are fine.

We had guest speakers. One was an anesthesiologist who talked about cesareans. I barely paid attention. Same as with the La Leche League leader... I can't recall what I was thinking, but it was probably something along the lines of: yawn How hard can this be?

We made no friends in class; it was simply too large! I'm sure I asked questions (I tend to do that) and that probably alienated some folks, but I just remember faceless bodies in that class... tired and cranky. Hard to believe those babies inside the bellies are almost 22 now!

When we took a tour of the hospital, I paid close attention... straining to hear others in labor... fascinated that babies were coming out of vaginas right behind the nearly-sheer curtains. (I didn't think about the DR they were moved to.) We were shown the Birthing Room... a freshly painted, beautiful, cozy room that hid the equipment behind cupboards. A double bed! We all oo'd and ah'd... and a stereo with cassette player! I heard comments from nurses around the corner that snickered saying only doctor's wives got to use that room, they didn't know why any of us ever got shown it except bragging. I shot my hand up and asked if Medicaid women got to use it. Oh, sorry... cash pay only. I was, once again, shown my place. (Cash pay would certainly limit the use of the room, too, eh?)

Then we saw the Labor Rooms... a bank of rooms, side by side, cubicle-sized... open doorways, covered by that sheer curtain. The bed was THE focus of the tiny space, but we can bring a chair or cot in for your Coach! A monitor (archaic by today's standards) was nearly a quarter the size of the bed against the wall and it was a requirement to be monitored throughout labor... in bed. Shaving was required. An enema, required. Nothing by mouth after admission (really, once you knew you were in labor!), required. I didn't question any of these rituals. I had yet to find my Birth Power!

I awoke after a few hours, feeling somewhat damp and couldn't figure out if my water had broken or not. I told bf we needed to head in to be checked. Bf was used to being awakened in the middle of the night to fetch me stuff. I ate my weight (and it was considerable!) in Bomb Pops, frozen Snickers, Sno-Cones, and Slurpees (I was pregnant in 9-month long Florida summer).

Off we go to the hospital where, in triage, they use one of those paper thingies to see if your water was broken or not (Ph paper... now I know what it is). Mine was.

I was admitted and excited as all get out that I was gonna have a baby!! WOW! I changed out of my clothes into a too-tight johnny (gown) and hopped into the bed, got m'self a shave and enema (humiliating), hooked up to the monitors, got some fluids in once the IV got going, a BP cuff permanently around my upper arm, and then the pitocin was started. I laid semi-inclined on the hospital gurney-like bed (very narrow for my fat butt) and watched the clock. I was no centimeters dilated and not effaced much at all that they could tell. I was 9 days post-dates.

Time passes, contractions begin... shoo doggie, they hurt! I got a shot of Demerol at 3 cm and another one several hours later at 4 cm. That was all the medication I had, though, because I think I kind of got into the flow of things. Huffing and puffing way too early (according to the books), but it helped.

Bf held my hand with every contraction. It got late, he got tired. Somewhere along the way, they brought in a cot for him and he slept (fucker!). He said I was sleeping through contractions, but I didn't believe him. He said he "listened" for the click click of the monitor as it began registering the contraction (these were the old time monitors that had pen-like arms that squiggled ink onto the papers... like what you see them measuring earthquakes with) and he would be there... holding my hand. I moaned. A lot.

I never considered getting up. Never considered anything but being there and doing what they said to do. I never thought about why I was there; a reminder might have been good. I remember, everytime I opened my eyes, seeing the clock... moving in slow motion. I was alone.

Except when vag exam time came... every hour on the hour. Membranes ruptured? So what! Different nurses (I saw three shifts) almost every time. People in and out of the curtain... emptying trash... listening as other women moaned, screamed, were wheeled by, nurses laughing, making jokes, plans for their days, talking about the kids... endless silence in my own room but the clicking of the monitor and my moans during my own bodyquakes.

Once, near the end, a bevy of nurses fly into the room and start yelling at me to turn over! Then to get on my hands and knees! Confused, I follow their screaming orders, not having a clue what is going on. Cord! Cord! I hear. And just as suddenly, once I am on my left side, I watch them leave without another word.

The next party trick becomes Magnesium Sulphate. Too much weight. Blood Pressure is high. Might feel sleepy. I can barely decipher the words. I know that my doula and midwifery clients who have had Mag Sulphate feel like they were run over by a truck, but I don't recall any difference at all (might have, just don't remember). Perhaps I was already feeling squished on the asphalt?

Oh, now I'm 10? Those magical numbers we have been waiting for!! Time to push. I'd wanted to push since I was 6cm and had to blow for MANY hours (my mind says, "fucking hours"). At one point, bf shot some Binaca in my mouth and I nearly sliced his head off with my tongue and dagger eyeballs; he didn't do that again.

I begin being coached to push... upside down beetle (cockroach) position... legs held back, cunt in the air, the whole world looking down at my woo woo to see how productive I am. I am mortified that I feel poop oozing out. Oh, you had an enema, there's nothing there. Bullshit. (No, Barbshit.)

Then, the worst of the worst of the WHOLE experience. I had been pushing for maybe 20 minutes and my MOTHER decides she wants to come and say hi. My MOTHER. I am gutteral and no one gets that I do NOT want her seeing me like this. I convey I want a sheet and BEG them to make her leave when the contraction comes.

My family is not a naked family. I saw my sister naked for the first time on a topless dance floor. My family doesn't talk about anything Down There. To be pushing out my yoni AND my poop and have my MOTHER in the room? Oh my god; impossible.

She came in... says she has been in the hall listening as I worked so hard. Can I die right now?! People can HEAR me?!

A contraction sweeps over me and I begin pushing again and somehow get bf to get my mother OUT of the labor room.

I guess I pushed fine and after 90 minutes, I was wheeled into the Delivery Room. Everyone was bright in greenish-blue scrubs. I was away from the offending hallway where my mom could hear me. I had a little hat thing on and booties. Bf was gowned, hatted, bootied, AND masked! They all masked back then (you should see the archaic pictures). I remember looking at the clock and thinking, Oh, I will have this baby before General Hospital is over! What a weirdo.

So, my legs are thrown wide apart into stirrups and I am strapped down in them. I have my hands free, but instructed to pull on the grips and NOT take my hands off them. Do NOT touch anything blue (can I tell you how many times I have used that stupid line!) because it is the Sterile Area (as if God made it and it can't be contaminated... puhlease).

Time for the episiotomy... novacaine... LOUD snip... snip again... big baby... snip again. My baby was coming out. I was pushing and my baby was coming out!

I watched in the mirror they had anchored to the wall. It was like watching myself on some reality show that didn't exist back then... but further away... muffled. It wasn't me; I couldn't feel.

My son (testicles!) was born and flipped over... everyone shouting, It's a boy! and then the cord was cut and he was taken to the warmer. A nurse took pictures for me to see later. He looked cranky. I shout out his name: Tristan Ian! and over and over, I hear how BIG he is... and when they weighed him (too fast), he was 9 pounds 4 ounces. Off to the Nursery to be poked you go, big boy.

I shook and shook as the doc sewed me up. The requisite Should I add a stitch for you? to my bf and he sat there kinda lost. He was escorted out to go tell the relatives and I laid there feeling bizarre with this needle going in and out of my vagina... an attempt at making it all better again.

I went back to the Labor Room for Bonding Time and Tristan was brought back. The pictures are priceless because I was SO obviously pre-eclamptic (my face a complete bubble), but I am beaming with pride! I nursed for 30 minutes before they took him away (no help. blessedly we caught on together quickly). Bf and I slept until we got moved to my room where cookies were waiting for me!

I didn't sit for over 6 weeks and went in twice to have my episiotomy looked it (it was oozing green), but everything was normal, I was told. Never mind the next door neighbor had had an epis and she was sitting flat on her butt in 2 days. I didn't understand. Way later, once I got my records, I found that I had had a mediolateral episiotomy that was extended into my thigh muscle. Gee, no wonder I couldn't sit, eh? Why no one explained that to me is beyond me.

Oh, and remember Tristan's deformed hand? No one explained to me that sonos (back then) saw bones, not the surrounding skin and his hand was clenched... but not deformed into a claw. When women come to me now and tell me how strange the sono looked, I explain the mechanics of them so they can "see" it better. Although, today's sonos are amazing! Back then, they were cursory... now, so detailed!

I didn't poop for about 5 days postpartum. I was drinking tons of water and taking my Ferrous-Sequals, but I could not poop. I was in so much pain one night, I called bf at work and made him leave to go buy 2 Fleets (I needed a colonic!) and bring them to me immediately. I sat on the toilet rocking for hours... struggling to poop out a cement truck.

I had pooped a tiny bit by the time bf got home, but did the Fleets... two at the same time... and then proceeded to just water the toilet. No help at all. I was sobbing and considering going to the hospital when, finally, a HUGE gigantic mass of poop jetted into the toilet. I was so relieved, I felt faint. Then, I looked in the toilet and it was filled with blood and poop. No wonder I felt faint! I bled for another few hours... peeing blood out my ass... not telling anyone because I did not want anyone going up there.

(I was diagnosed with a colonic tear after Meghann was born as it tore open again and it wouldn't stop bleeding for 2 days. I was scheduled for surgery, but MADE it stop bleeding because I did not want to have surgery 3 days postpartum after a homebirth! It tore once again after Aimee's birth, but this time, the blood collected inside and did require surgery to repair when Aimee was 3 months old. More on that in Aimee's story.)

Tristan and I spent a lot of time together getting to know each other. Nursing was great, although we didn't co-sleep (I didn't know the concept then); he slept in a drawer next to the bed. I wore inappropriate nursing clothes when we went out and often found myself in bathrooms with my dress hiked up under my chin. Once, we went to a play, and I sat in the hall on the floor listening to it as I nursed (why I didn't nurse in there... odd to me now). There is a picture of me, angrily nursing, because I had gotten all dressed up and couldn't even have one night to be out and not nurse. It's absurd to me now!

Bf and I got married when Tris was 2 months old (right before bf's 18th birthday) and my mom kept Tristan that day while I got ready, but was supposed to bring him to me to nurse before the wedding. Mom was late (always, ALWAYS is) and I had to get married with rocks on my chest and leaking onto my dress. I nursed the second I got to mom's house where the reception was, but then we went and honeymooned without Tristan at Disney World for a night. My poor breasts. I was drunk and leaning over the sink in the hotel room hand expressing while my new hubby snored his drunkeness off on the bed. I can't believe my ignorance back then!

I had pumped for Tristan, for my mom to feed him that night, but she said by 8pm, she was at the store getting him formula. I'm sure that helped his later allergy issues.