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.

Tuesday, August 10, 2004

F/u for Maternal Death Post

Already, I have gotten email asking why this mom died... how did that happen... could it happen at home... what meds did she have in labor.

While they pretty much knew why before the autopsy, the diagnosis stated that she did, indeed, die of an amniotic embolism (amniotic fluid embolism... AFE)

Here are a couple of sites to read about the syndrome:

http://www.emedicine.com/med/topic122.htm

Here's one that has case studies where women lived:

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol5n4/amniotic.xml

AFE happens at home, in birth centers, in hospitals, in ORs during cesareans. It just happens and no one really knows why.

Some women feel, once they know about AFE, that they are safer in hospitals so they can do something if it happens. I have heard of 3 cases of fatal AFE in my life (including the one I witnessed) and they were all in the hospital. Granted, by sheer numbers, the odds are greater, but the hospital did not save the women. The babies did, all live (1 was already born with the AFE occurred), so yes, a cesarean could possibly save the baby if done quickly during the crisis. But, by looking at the stats, even that isn't a guarantee... and, sadly, many of those children are compromised.

The mom whose death I witnessed had no medications at all during her labor. She did have an IV, but only with Lactated Ringers. IVs do not cause AFEs... women have had them without them.

I know all the discussions that revolve around my story. I have heard them since she died in 1987:

What if she had been up walking?
What if she hadn't had a vaginal exam?
What if her waters weren't broken? (they were not artificially broken, she ruptured her membranes spontaneously)

Believe me, if there was something that caused this that someone could pinpoint, we would surely not do it anymore... it is that dramatic.

(I am reminded of Star Trek IV [again! someone just mentioned this the other day] when the doctor is in the hospital and sees a woman going in for Dialysis and he comments how archaic that is! and fixes her immediately. I pray that is what will come to pass each day I work with pregnant and laboring women; that something miraculous will be discovered and women will not have the risk of AFE ever again.)

I often say that midwives are a product of their experiences. (Everyone is, but midwives make judgement calls based on theirs.) This woman dying in my sight kept me from midwifery for another 15 years. I simply was not mature enough emotionally or spiritually to take the lives of two people in my hands.

I am sure that pisses off many UCers reading this... that those lives aren't in my hands. But they ARE when someone hires me to keep them alive should one or the other... or both... need to be re-lifed until help that surpasses my skills arrives to take over.

When I had Tristan, I was so inducted in the Medical Model, I thought his birth was perfect! (I promise to write it out soon... all three of my own birth stories are over-due.) I wrote letters thanking the hospital... thanked the nurses with flowers... the doc with chocolate and a letter of praise.

When I had Meghann, I was angry with The System. My Bradley class taught me all I needed to know to birth alone and, I thought, safely. Dr. White's Emergency Childbirth on the dresser, visualizations of perfection continuing, dozens of books under my belt... and endless discussions with Marilyn Moran (the founding mother of American UC)... all served to help me feel more than ready to have a baby without the hindrance of a midwife or doctor or hospital. I could do it!

And then Meggie nearly died from a shoulder dystocia that no one knew how to resolve. Blessedly, the Universe/God/Nature/her Spirit, twisted her out and she was born needing resuscitation and reviving... a few pumps of her heart with fingers, included. It was terrifying.

I was still in that place of arrogance, however. She had made it. She was so beautiful! I had squatted and had a 10 pound 6 ounce child at home with no midwife, no episiotomy, no tear... delivered my own placenta... nursed perfectly. I was HIGH!

Pregnant with Aimee, I watched this woman die and my pendulum that had swung so widely between Tristan's and Meghann's birth... finally found its center.

I have remained in that center.

Even as I explore a more hands-off birthing style, I am ever grateful and thankful that I have the skills I have... and that I have them available should women want and need them (and their babies, too).

I found humility that day.

I thank the woman for the gift she never consciously knew she gave me... she gave me the maturity to wait many more years... she gave me balance to see that doctors aren't all animals out to eat their prey... that even the most repulsive men and women can work until they fall to their knees to save another human being. I watched men and women, whom I had written off as having no souls, sob into each other's shoulders and their own hands. She gave me a reality... a biting, painful, slapping reality... I had never expected in birth. Hearing about death is one thing, but witnessing it is completely something else.

Witnessing death in birth... another thing altogether.

Thank you, dear woman, who gave her life so I might gain mine. You will never know the gifts I have received.

Maternal Death

I had had that sucky hospital birth, then my UC with Meghann and, even though I had trouble (shoulder dystocia), I was still euphoric with the Perfection of Birth when I was pregnant with Aimee in Frankfurt, Germany. I was doula-ing for women regularly at the Frankfurt Army Regional Medical Center... sitting happily with CNMs, RNs, and even some of the docs... asking a zillion questions about birth. I was more than a dry and parched sponge; I simply could not learn enough even with the 10 books I read a week on birth (no Net or tv or videos back then!).

One of the nurses called and told me a woman needed some help, could I come and help her out. Sure!

I got up there and worked with her for a few hours... it was really nice. She had some nubain, so was dozing and I was out talking at the nurse's station and another nurse came and said a woman really needed a happy face for a minute... could I please come and talk to her. Absolutely.

I went in and spent about 10 minutes with a sweet couple... talking about their baby coming... helping her move from tears to smiles... and we had a couple three contractions together. I held her hand.

I was sitting at the nurse's station as she was wheeled to the Delivery Room and I went and stood outside the door to watch her have her baby.

As she began pushing, the usual scene unfolded... she was draped, she grabbed the hand grips, her man at her head (dressed head to toe in blue-green), and the nurse and doc were exhorting her to push.

Then, hell entered the room.

The woman passed out and she began bleeding. A nurse hit the button on the wall and a storm of green came from every orifice of the hospital. Within a blink, the father was shoved next to me, anesthesia was gassing the mom, and blood began pouring everywhere. Creeks, rivers, oceans of blood.

This mom still encased her baby and I could hear the docs screaming with confusion about what to do first... get her under anesthesia? was she already dead? just cut her open?

My head was swirling with horror and fear as I grasped the father's hand who was out of his body with fear.

I watched doctors I despised work until they fell down from exhaustion only to be replaced by other doctors I adored. I watched as the docs worked as they were trained to do; to save a life... it was their ultimate training and, for the first time ever, I respected that training.

I watched a choreography of bloody dancers, bagging and intubating the mom, doing CPR on her as she had heart failure, nurses who'd opened two more IV lines in her neck squeezing blood into her body... over and over... the anesthesiologist screaming to just get the baby OUT and the OB finally deciding it was time to get to the poor suffocating baby. 7 minutes hadn't passed since she entered the DR.

The floor was already puddled with red, but as the doc used his scalpel to open the abdomen, a waterfall of blood poured out of her body and over the table and I saw the mom begin bleeding from places I never imagined. Her nose, eyes, mouth, fingernails... her very skin turned red as she went into complete DIC (Disseminated Intravascular Coagulation). I thought I was going to vomit from the scene, but I prayed for the baby they pulled lifeless from her body.

Another team grabbed the baby and waded to the warming table and began working on the blood-covered baby. Wiping him with towels, they intubated and brought the baby to a groggy and brain-damaged life.

Dazed, dad went with the baby to the nursery and I went to sit against the wall across from the DR. I began crying and could not stop. The nurses and docs who filed past me gave me no notice whatsoever; they were in their own pain.

I had my other mom still in labor and she was going to be delivering in her labor room (highly unusual) so no one had to go down to the DRs until things were tended to and cleaned up. From down the hall, I watched as the mom, under a clean white blanket, was wheeled down to the morgue... and I walked into my client's room, held her hand, breathed with her, and watched as her precious... oh so precious... baby was born.

They both lived.

Perfect Visions to General Anesthesia

What is it about birth that is so unpredictable sometimes?

It is common knowledge amongst caregivers that those that live in their heads (dancers, athletes, computer geeks) have the hardest time allowing birth to happen in their bodies. Some women take several childbirth classes and read a hundred books, all in the hopes of conquering the mysteries of birth. But, those mysteries are different for every woman and not taught in any book.

In 21 years, I have known 3 women to have general anesthesia for their cesareans. 2 in the last year. I find that incredibly odd.

In preparing for The Perfect Birth, women read all the "right" books, take Bradley and Hypnobirthing classes, hire homebirth midwives that believe in them, hire doulas to tend to the needs the midwife or partner can't or doesn't... and visualize, meditate, pray... all in the dream of creating a peaceful, wondrous (usually) waterbirth.

Labor arrives (or not) and obstacle after obstacle falls in the way of that Perfect Birth. The due date comes and goes far, far away... membranes rupture long before labor begins... blood pressure climbs... a posterior labor digs into the pain threshold like no one else can understand... a fever elevates... fetal heart tones do funky things... exhaustion sets in.

What is the lesson? Is it surrender? How much does one have to surrender before the obstacles vanish and something resembling the original birth desires materialize? Even when the woman does surrender, I still see the Universe throwing shit at the woman's birth plan: she gets the crappiest doc on-call... the vacuum doesn't work even after 3 tries... the baby is too high for forceps... her vagina gets cut and THEN she has a cesarean... the spinal or epidural don't take... and then she is out for the entire birth. Why do some women have to experience this?

The worst is that 2/3 of the women I know who had this experience will never birth again (choice), so replaying their births differently will never happen. Therapy, talking, rebirthing, etc. have still not quelled the pain of not being there for their babies' births (consciously).

I speak often to women who talk to me about their Perfect Births... about how there are 2 players in this game of life. That mom might be totally evolved and ready to birth the way she visualizes, but the baby might have its own agenda (don't they always?) and might need to be born out the belly instead of through the vagina. Perhaps in another day and time, out the vagina might have meant death and they remember that, so choose out the belly instead. Surely they know things we don't know about how to move inside the uterus, right?

What happens when there is direct conflict between two extremely powerful people's needs?

Someone gives in. Oh, sorry... the common (PC) word is "compromise." cough

And if mom isn't the one to give in, the baby does... and one person's needs vanish.

This is my issue with UC. Whose will wins?

taking a break for a few minutes

I don't understand so much about birth. I wonder if women in the jungle ponder their birth stories as much as we do. There is no need for marriage counseling in cultures that have black & white rules about what marriages look like. Someone might be unhappy, but that's just the way it is.

Women's vaginas fall out in Africa. Women's bladders fall out in Asia. Women struggle with bodily injury due to their caregiver's inability to respect and help properly. From what I know, they don't call it birthrape. Are we thinking too much? If we lived in a subsistance culture, would we have time to worry that we can't write a letter because our midwife yelled at us? Our culture affords us too much time, I think. Blogging probably isn't a priority in Ecuadorian pueblos.

Navelgazing can often spiral into vertigo.

Monday, August 09, 2004

Donna's Birth Story

This story is one part of the catalyst for my transformation as a midwife. I will write Connie's birth as another part soon. Of course, each birth that I have witnessed or participated in has assisted the growth and change, but Connie and Donna were very much my ChangeMakers.

Donna's telling of the story is very different than mine... similar events, but each of us has the timing off somewhat... irrelvant to the actual feeling of the birth. In Donna's story, I am but a comma in her novel and I love that about this story! This story, from her perspective and her family's, is this IS their story. Not the midwife's. That is the highest compliment.

The story below, as written, will appear in the Dec. 2004 issue of Midwifery Today.

This birth story is different from any I have ever written. As I share it, I watch my words go into midwives’ ears and minds and watch as they try to grasp what I am saying. During most of my life as a doula/midwife, I would have thought, of myself, "What a fruitcake!" But the moral of this story is: I serve the mother and her family—in whatever way she needs me to.

My client, Donna, was pregnant for the eighth time. She had had three hospital births (each with a different doctor), four homebirths (all with same midwife), an episiotomy or tear with every birth, one shoulder dystocia that resulted in a broken clavicle (homebirth) and three stuck shoulders (homebirths). Midwife management and unwelcome comments during the last four homebirths had inspired Donna to find another midwife (me!). Donna and I had "known" each other more than 15 years ago in La Leche League, but she had quietly watched me share about my midwifery style on an Internet list before choosing to talk with me.

You see, she wanted Unassisted Childbirth (UC or UnaBirth, sometimes Freebirth), and a couple of births previously, her husband would have agreed. But after some (midwife-perceived) issues at the last delivery, he had insisted on a midwife. Donna’s compromise was to find a midwife who would keep her hands off and her thoughts to herself.

As we got to know each other, I learned what she wanted. She wanted me to be there in case the baby needed help getting started or she began hemorrhaging. That was pretty much it. While I have a fantastic hands-on midwifery education from Casa de Nacimiento and a plethora of clients from years of birth center and homebirth practice, I have been feeling myself less inclined to do something and more inclined to keep my hands out of the vagina—to trust that what I see and hear is The Truth that no cervical dilation can translate. It has been quite an evolution.

At 39 weeks and four days along, Donna’s daughter called and said, "Come now—it's soon!" I flew out the door (without makeup—unheard-of for me!), calling the other midwife (a licensed midwife whom Donna had gotten to know as well), and arrived at 5:20 pm; the other midwife at 5:30 pm. (Baby was born at 5:59 pm!)

I was surprised to see Mom (naked) and Dad (clothed) in the blow-up pool (after four waterbirths, she had debated having another, thinking she would want a land birth this time). The first pool, nearly filled, had popped, and the older girls had had to run out for another pool!
All the kids who were able helped me carry in my equipment (I have two giant soft-side cases and two O2 tanks in Iron Duck bags). Then I entered the home, softly, breathing deeply before entering the room where the pool was.

I watched for a moment, waited for the next contraction—and then for her to blow that last contraction away — and asked how she was doing. They said great, and I asked if the baby was moving. She nodded and said a soft, "Yes." I asked how she was feeling. Drinking? One of her children brought over her Red Raspberry Leaf tea for her to sip. And then I retreated to set up the equipment, quietly, right outside the room. The other midwife came and helped me. We checked everything—oxygen on, birth kit at the ready, med tray with syringes prepared—and then we sat and watched quietly.

Mom started grunting, and I heard her whisper that her water had broken. It was clear, so we charted that. She started pushing and, I know from her history, that the head is the most challenging part for her, because of her previous tears and episiotomies, and the only part that truly hurts. As she was on hands and knees, leaning on her husband, I heard her say: "I am scared. I am scared." Her husband whispered to her, but she looked up at me and said, "I am scared!” So I knelt down in front of her face and gently told her that she could do this. I suggested she put her hand on her baby's head and feel it come out slowly. No matter what happened, we could take care of it. She pushed a little more—and the head was out!

Everyone's attention was at her bottom end. I was sitting directly near her face, and she had the most glorious picture of serenity and ecstasy. It gives me chills, even now! I felt so honored to have witnessed her bliss in those few moments.

She waited for another contraction and asked everyone to come to the other side. I moved backwards, as she began pushing her baby out. Momentarily, she thought the baby was stuck, and her husband reassured her that he felt shoulders, but no cord, and the baby plopped out of her body. I moved to the side of the pool, just watching, as I could see a tight cord around the neck—twice. As they began to lift the baby, the short cord interfered, so mom and dad both pushed the baby back down and unraveled the cord. When they brought the baby to the surface, s/he took a giant breath, sighed a loud, “Ahhhhhh!” and made little futzy noises. Mom sucked out a little mucus with her own mouth, nothing dramatic, and mom and dad just “Oo”-ed and “Aah”-ed over their latest addition.

The baby latched on quickly (12 minutes postpartum). As mom stood up and stepped over the side, about 15 minutes postpartum, a gush of blood mooshed into the water, and I heard the other midwife whisper into my ear, "Do you want to check her fundus?" I said, "Nope," as I watched this very alert mom talking to her family as they made guesses about the baby’s gender. They didn't look for about twenty minutes—it was a boy. They now had four boys and four girls (“A matched set!” mom said).

I could see that the placenta was detached (separation gush, no trickling) and asked mom if she was ready to deliver it. She wanted to wait a couple of minutes, and that was fine. When she was ready, we helped her stand. I stood underneath with a chux, she pulled the cord a bit, and out plopped her placenta (6:25 pm). We had her cough, because there were trailing membranes, but those came out just fine. She sat down and nursed her new son and her toddler! I took pictures.

Donna was not ready to cut the cord, so we put the placenta, in the chux, in a bowl next to her (she had seriously considered a Lotus Birth). After an hour or so, she went to her bed with the baby and the placenta in the bowl. She got up to pee, and there was no tear! This was her first birth without a tear. As she showered, dad held baby. Then she hopped back into the bed, where she did the newborn exam (a cursory look to see how things were. I wanted to see the spine to make sure there were no spinal cord issues; everything else could wait). I pulled out my flannel sling, and dad weighed the baby (it was the first time they had weighed their own baby). I stood by, smiling. I went home after this, but returned for a more in-depth exam of the baby the next day.

The greatest part of this birth was the “firsts”: the first time their child did not have a bulb syringe shoved up its nose (mom’s words); the first time mom and dad were the first to touch him; the first time dad got to catch his child, despite four previous homebirths, in which, at the last minute, the midwife had jumped in the way; mom’s first time not tearing; and the first time she had had no vaginal exams (during the entire pregnancy OR labor)—the first time she was the one who called the shots. This was her birth—hers and her husband's and family's. It was such a privilege to witness.

Neither the other midwife nor I ever touched this baby that entire first day. It was one of the mom’s major requests, because all her other children had been dressed by the nurses or midwife. She wanted this child naked! It was odd to not examine him, and I wouldn't do that in every circumstance, but she knew what she was doing, and I honored her desires absolutely.

The only piece of "equipment" I used at this birth was my sling scale, and I was not even the one to use it— dad did. I left them my scissors and a clamp to cut the cord when they were ready (about 20 hours later, and mom got to cut this cord—yet another first). Otherwise, I did nothing but observe and be there for what she hired me for: emergencies. Someone has commented that I was doula-ing, but I was midwifing. I was watching her clinically, judging blood loss, watching the baby closely for breathing issues, etc. I just didn't have to do anything. How cool is that?

The other midwife and I were totally blown away by this birth, and it caused us to re-examine our beliefs about what a midwife needs to do at a birth and what a midwife could do at a birth. I was more relaxed than the other midwife about moments of concern, such as the blood loss or the baby not being totally pink while still in the water, probably because my relationship with the family was more intimate. But the other midwife was loving and gentle and respectful as well, the whole time. We were merely witnesses to the most fabulous experience of our "careers" as midwives. While I am glad I have the clinical skills I need in an emergency (and many I don't need in an emergency), it was the best lesson in the world to use everything but my hands at this birth. My mind, eyes and spirit were my midwifery tools that day.

Donna has told her friends and family this was The Perfect Birth.

I am humbled and blessed.

Sunday, August 08, 2004

The Other Voices

This will be an on-going list that began out of my birthrape blogspot. I asked others to write me and tell me what was said to them that I hadn't heard myself. Already, I am getting painful emails filled with stories of disrespect, disbelieving, and sometimes, disgusting examples of what others, who are supposed to be caregivers, have said to women in pregnancy, labor, birth, and postpartum.

Please send your examples to me, Barb Herrera, at msgardenia@cox.net

-------------------------------------------------------------------------

* There's not much happening here (as the midwife does a vaginal exam)

* One woman wanted to stand on her own during her births, but, both times, was forced to do a deep squat or be supported by others, causing vaginal tears and "mad" that she wasn't honored at her own births (her words).

* I had a midwife write me thanking me for disclosing what she, too, has seen in her training. Blessed Be! I am not alone!

This next series from a nurse friend of mine:

* "Stupid Bitch" (said by a Doc before he even left the room)
* The same doc (we hated this prick, he still practices) elbowed a woman (hard) in the thigh because she wouldn't open wide enough for him
* "Well, the Anesthesiologist is here now for another pt and he wants to go home, this is your last chance for an epidural"
* "If you would just stop moving we could get a good tracing on the baby" (and other variations of the same)
* "Quit being such a baby"
* "Oh come on, it doesn't hurt that bad, you are only ____cms dialated."
* "These stupid wetback women just scream and scream, I wish they would shut up" (same prick as above)
* "If you don't hurry up we will have to do a c-section"
* "No way is that one going to deliver vag, did you see the size of her?" (I personally have never seen a vag delivery of anyone over like 200, that is after preg weight)
* "No you can't walk because you are on pit" (everyone I have ever seen in labor was on pit)
* "Walking doesn't do anything for labor" (said by a doc, different one than above)
* "Oh no, she has a birth plan"
* "If you wanted to walk you should have stayed home" (after her IV is in and she is on pit now)
* "Give her a sleeper already so she will be quiet and stop bugging us"

Signs

Second time mom, first homebirth after a very difficult hospital vaginal delivery for her first... lovely couple, 5 year old daughter... and mom is in labor. I hear noises as I run in from outside to see if birth is imminent and toss my stuff down, stethoscope on the dining room table that is laid out with food (grandma was there taking care of everyone).

Another midwife is there (again, I am second assist) and we sit with mom for a few minutes as we assess what is going on. The other midwife checks her and she is about 4cm, so we know we have time to get our equipment and such together and set up.

I smell something foul.

Wrinkling my nose, I walk out into the livingroom and there, on the dining room table, is my precious Littman stethoscope on fire... nearly fired in half. I slammed something on it (a plate of hummus?) to put out the fire and then shook my head at the stupidity of throwing something onto a table with no less than 5 candles burning. (The duck story after this blog story happened less than a week after this!) Dang, did it stink in there. We opened windows and fanned things (it was December) until we were freezing too much.

Labor progresses slowly and mom, a beautiful, sensual, big woman, decides it is pool time, so she climbs into the blow-up birth pool we sell and proceeds to make it her new home. As the hours pass, we continue our emptying and re-filling ritual I call Going To The River since it is removing water with pans and pitchers and refilling with kettles and pans of boiling water... walking to and fro, over and over, hours at a time.

We were tired and one midwife was dozing on the couch a few feet from us. The assistant and I were leaning close to mama and dad was also kinda dozing behind mom who was dozing between contractions, but moaning beautifully during her surges. We all kinda zoned between contractions.

The dog of the house had an itching fetish, so had to wear a cone around her neck at all times. We chuckled at first, but got used to it. The kitty thought we were nuts and kept coming around trying to see what mom and dad were doing (sis was sleeping with grandma during much of this). The cat sat on a chair next to the pool so she could watch mom in labor and, in a moment of impulse, the cat tried to jump into the pool! She missed. What she did get done was she got her claws dug into the top ring of the pool and it began leaking.

Suddenly, we were all bolted awake... looking for tape, talking calmly with mom who was laughing, too... covering the claw holes... and then looking for the bike pump to pump the ring back up. (Where was that patch kit that came with the pool anyway?!)

As things settled down again, mom was leaning her head on the pool and it slowly deflated. As her ear would touch the water, the assistant would use the bike pump to pump up the ring again. Mom's head would inch its way out of the water, up to the proper place again, only to have the experience repeated every 15 minutes or so. It was so funny to see... down, down, down... up, up, up! She wasn't bothered by the movement at all.

Easily, 2 hours of this go by and the dad pumped once instead of the assistant, and he took the pump hook-up out of the little pokie thing in the pool. Miraculously, the pool didn't deflate anymore! We should have just pumped up the pool and disconnected the pump... would have saved hours of pumping, mom's ear in the water, and laughter. Well, the laughter was a good thing. smile

During one time that mom got out to wander around, she was swaying during a contraction and a spider on a web dropped from the ceiling... right in front of her... dropped fast... and then abruptly stopped in front of her face! The spider swung there for a moment or two and then continue his/her descent. We looked at each other and laughed. This birth was getting to be rather amusing.

On cue, the dog walked in and we turned our heads sideways to figure out what was different. The cone was gone! Dad walked around the house and outside looking for the cone, but it had vanished. Maybe someone walking by took it off? We couldn't imagine the dog wouldn't have barked; it was only 5am.

Not long after dawn (we sent mom to dig her feet and hands in the earth to remind her Self of her basic connection to it... right up her alley of requests for us to do), mom had a giant little boy with everyone delighted and amazed at his beauty and enormity. Once everything was tended to, we left them to heal and bond.

I did the postpartum visits on days one and three. On day 3, I had an intuition to go to the corner of the yard and dig. Within two digs, I found the dog's cone. I debated taking it back to the owners (thinking how clever of the dog to hide something that annoyed her so much!), but she was scratching herself raw and that was worse; she would have to be medicated a lot for it and possible infection, so I returned the cone to the owners. I swear the dog stuck her tongue out at me.

Mom talked about all the signs she had that laughter was so important in this birth. She, usually happy and laughing, tended towards being kind of morose and somber during labor. The humorous things that happened brought much-needed levity.

I often use humor to remind people of the joy that is happening. Sure, labor is work, but it can be joy-filled work!

I have several new stethoscopes now (all Littman) and am very careful where I toss them.

laughing

Duck on Fire!

A beautiful labor... second generation homebirthing mama with 13 family members in the room (all homeborn but one), plus the cutest white dog you have ever seen. One sister had a video camera going for hours... labor was nearing its end, mom was feeling grunty and began pushing on her side on the bed.

As is typical with birth, the energy pulls people in in a spiral motion... the spiral starting further out early in labor, and the spiral closing tighter until the actual birth and then the spiral reverses and starts moving outward again. Because birth was close, everyone was tightly surrounding this lovely mama.

Her midwife (I was a second assist) always has ice for pushing because many women find the ice soothing. As this mama was pushing, she, without opening her eyes, says, "it's burning" and the midwife says, "tell me where and I will put ice on there for you."

Mom's eyes fly open and she says, "Something is BURNING!" and we all look up and not one foot from my face is a down comforter on full fire next to the bed. The midwife jumps off the bed, grabs the quilt, runs across the room with it (as embers are floating behind her!) and she tosses it into the baby pool mom hadn't gotten in at all during the birth, popping the top ring on the pool, but putting out the fire. The room started laughing hysterically at the very weirdness of the experience and the mom, having a baby (for crying out loud!) hollers at everyone, "Shut up! You all shut up!" and we stifle everything we can behind our hands and tight lips.

Mom has a beautiful girl not long after and when the subject of the fire comes up again, now we all could laugh and talk about it. The sister who had been been videotaping tells us that she had to change tapes during the Running of the Comforter! On the tape, you can see the client laboring, a huge flash of light in the corner, and then black... and then the birth. We'd missed the whole thing on tape!

The most bizarre was how, of all the people in the room, the laboring mom was the one to smell, see, sense the fire. It is yet another indication that women in labor are not so out of it they have no sensibilities.

The client tells us that when another brother came over the next day, he looked into the baby pool and saw the charred feathers and said, "What, didja have a duck?"

This client is pregnant again (my client this time) and we promised not to throw comforters on candles during the birth. laughingsmile

An aside: This baby walked at 9 months old. Well, ran at 9 months old! I had never seen anything like it before. I went to their home and she ran in the yard with knee-high grass! It was like watching a computer graphic, that's how surreal it was.

Saturday, August 07, 2004

A Different Kind of Pain in Childbirth

Note before beginning!

This can be seen as a VERY negative post. Even in that light, there absolutely is a balance... a mirror image of the goodness and love and kindness I have seen in birth, too. But this blogspot isn't the space for that. I will do that another time. This is for enlightenment of a different sort.

As most who are reading this blog know, I am also processing issues surrounding birthrape and how midwives (not just OBs and nurses) facilitate the birthrape experience for women.

(a definition in the making)

Birthrape: The experience of having fingers, scissors, and/or tools put/pushed/shoved inside a woman's vagina or rectum without her direct (or indirect) permission.

Being coerced, manipulated, or lied to regarding the health and safety of the baby or themselves so the midwife is able to do something to the mother's vagina, rectum, cervix, or perineum, usually with excuses; rarely with apologies.

Some find the definition expanded to:

The midwife taking the woman's Power by using disparaging comments, unsupportive expressions, speaking around her as if she is unable to hear or process requests or information.

and

Even though consent forms are signed in the hospital, birth center, and at home, consent for care does not include the manipulations or coercive words to get women to obey the caregiver.

I thought it was time I shared some of the thousands of comments I have personally heard that have facilitated birthrape over the years.

I share them and am writing about them and speaking about them and nearly screaming about them in the hopes that midwives will hear what they are saying that is sending their clients into therapy, pushing them to depressions that require medication and alternative therapies, keeping them from coming back to the midwife at all because of her Power Hunger and covert misogyny. Too many women (in my opinion) find Unattended Birth their only acceptable option after their experiences with professional caregivers in birth.

You see, most midwives talk a good game. They will say any number of things in pregnancy to lead the woman to believe she (the mom) is in control. I have sat through hundreds and thousands of prenatals with midwives and listened to the party line about how they believe in a woman to know, how they will "let" them labor how they want, how they will limit vaginal exams, etc. And then, when labor is in full swing, I sit by (or participate) in the amazing disregard for the woman's prenatal wishes and dreams of an unhurried, unfettered, un-directed birth.

I am not a part of the delusion or lies anymore.

Common Beliefs
* Women in labor don't really want to use their birth plan.
* Women in labor aren't able to verbalize their needs.
* Women in labor don't know when they need to pee or drink or eat.
* Women in labor don't know when to change positions.
* Women in labor can't make decisions.
* Women in labor want an epidural.
* Once labor kicks in, they all want epidurals.

Directives That Disembody Her Being

* Lift her leg.
* Move her to the bed.
* Grab her knees.
* Put her feet in the stirrups.
* Put her hands on the grips.
* Push her head to her chest.
* Push her chin to her chest.
* Put pillows under her head.
* Put pillows under her butt.
* Pull her down to the edge of the bed.
* Push with her so she knows how to do it right.
* Count for her so she knows how to do it right.

(while these next phrases end in periods and question marks... almost exclusively, the following words have been shouted at women... an exclamation mark is more appropriate, but there aren't enough in the computer to add them all)

Comments That Negate Her Intelligence
(spiritual, physical, emotional, and intellectual)

* You aren't pushing right.
* Push like this.
* Quit making noise.
* No, push longer.
* Push like you are having a bowel movement.
* Push the watermelon out.
* Push the bowling ball out.
* Don't push in your chest, push in your butt.
* Push like you mean it.
* What are you doing?
* Can't you push harder?
* Have you ever been raped? (asked in labor)
* Are you an abuse survivor? (asked in labor)
* Have you been abused? (asked in labor)

Coercive and Manipulative Remarks


* I need to get in there.
* pressing knees apart - I need to do a vaginal exam.
* C'mon, just let me see what is going on.
* I'll do it quick and fast, I promise.
* I promise to be gentle.
* I just want to feel the baby's position.
* I just want to see how dilated you are.
* You asked me to be your midwife, now let me do my job, okay?
* I'm a woman, too, I know how it feels... I promise to be gentle.
* I remember how vaginal exams felt in labor, I promise to be gentle.
* Do you want the baby to come out or not? Just open your legs.
* Are you sure you are ready to be a mom?
* You had no problem opening your legs 9 months ago.
* Just let me break your water, it will speed things up.
* If I break your water, the head will be applied better on the cervix.
* If I break your water, prostaglandins will stimulate things nicely.
* Here, drink this. (as Gatorade with cytotec is given to the mom)
* You might feel a pinch. (as pitocin is injected into the vaginal vault)
* I am just wiping up some stuff. (as pitocin on a gauze is pushed inside the vagina or rectum)
* Here, drink this. (as blue and black cohosh are given without consent)
* Here, put these under your tongue. (as homeopathics are given without information or consent)
* I'm just feeling your cervix... it might hurt a little. (as manipulations to the cervix are done... from stripping the membranes to manual dilation)
* I'm just feeling your cervix. (as cytotec is put onto the cervix)
* Do you want your baby to die?
* You don't know the seriousness of the situation.
* You have been a martyr long enough.
* Just take the medication.
* Just get "your" epidural.
* Would you like something for the pain? (in the middle of a contraction)
* This will take the edge off.
* It doesn't do anything to the baby.
* If you were my daughter/sister/mother....
* I have had three scheduled cesareans myself! I don't know what you are complaining about. (being wheeled into the OR)
* Stop whining.
* Why are you crying?
* What is wrong with you? Are you trying to hurt your baby?
* In this day and age, no one needs to suffer in childbirth anymore.
* Mothers and babies died without hospitals 100 years ago.
* Let me call the anesthesiologist... just talk to him about your options.
* No, you can't eat... just in case you need a cesarean... and your labor is rather slow moving.
* No, nothing by mouth after 7 centimeters. (or any number the caregiver randomly pulled out of her ass)
* Only ice chips.
* Oh, Bradley... they always have cesareans.
* You wanted a homebirth? That's child abuse!
* Are you one of those La Leche League people who nurse until the kid dates?
* Do you vaccinate? (after discussion of no erythromycin in the baby's eyes)
* You want your baby to go blind? (after refusal of erythromycin in baby's eyes)
* Your baby might bleed to death. (after refusal of Vitamin K injection for the baby)
* It's just antibiotics.
* God, you have terrible veins!
* Where are your veins?
* (to the Licensed Midwife during a transport, a nurse asks) Do you know how to take a blood pressure? Did you do any?
* Why did you wait so long?
* Why did you get here so early?
* You aren't in labor.
* How would you not know if your water broke or not?
* Can't you stop moaning?
* Be quiet!

* Oops, your water broke! (while using fingernails or fingers to break it on purpose)

Whispering to Other Birth Attendants
* My god, I wish she would hurry up.
* I am so bored!
* She is going so slow.
* I wish she would let me break her water.
* My baby needs to nurse, I need to go home.
* My boobs are going to burst if I don't go home and nurse. She needs to hurry up.
* I am so tired.
* I want to go home.
* I am going to talk her into letting me break her water so she will hurry up.
* I am going to talk her into letting me manually dilate her so she will hurry up.
* I need her to hurry up.
* She's holding back. There must be some emotional barrier we haven't found yet.
* I bet she was abused. Look how she: keeps her legs together/cries with exams/doesn't want us to touch her/doesn't take her clothes off/won't take her shirt off/won't relax enough to let the baby out/is afraid to be a parent/hasn't worked through her issues/has body image issues/has eating issues/is fat/is thin/lives in her head/isn't in touch with reality
* She is so noisy.
* She is too quiet.
* She needs to let go.

---------------------------------------------------------------

I am exhausted writing this much pain. I know there are hundreds of thousands of remarks that have been said that I haven't been witness to and I encourage women who have had them said to them to email me privately so I might start a list that lets caregivers know what not to say to women during pregnancy, labor, birth, and postpartum.

Email to: Barb Herrera - msgardenia@cox.net

Your names, of course, are completely private. Your words, however, need to be heard!

Let's shout together!

Tegaderm

I had a doula client in Frankfurt... a nurse (relevant to the story)... who had herpes so bad during her delivery, she had it on her breasts, her fingers, and belly besides the lesions on her pubic area and mouth.

She still delivered vaginally and breastfed.

This birth is where I learned about Tegaderm... it was rare back then, but now, I keep supplies of it for many purposes, herpes being but one.

Tegaderm is a bandage kind of thing, but clear (and expensive!). Most people know it as the clear plastic stuff they put on top of your IV when they are done putting it in. Tegaderm is what we put on Sarah's operated-on eye during the fires and when she showered so nothing could get in it. We use Tegaderm with stitches so showers can be had without wetting them (I did that for all my biopsies). The literature calls it "transparent dressing."

In births now, we use it to cover the Hep Lock so women can be in water without concern for the IV site.

Tegaderm also covers lesions allowing for birth to occur without "contaminating" the surrounding area. We have done this in homebirth, too.

(I am avoiding the whole issue of shedding without lesions, the risk of herpes and newborns, the un-likelihood of any OB using Tegaderm on a lesion and allowing a vaginal birth, the possibility of lesions inside the vagina or on the cervix that Tegaderm cannot touch, etc. I am merely sharing a story of an experience I was a part of.)

This mom had a quick labor and wore a glove on her herpes'd hand, Tegaderm everywhere else, including her outer labia that had several lesions. She Tegaderm'd the lesions on her breasts (they were not on her nipples) and brought her baby to her breast as she nursed wonderfully after the birth. She had a lifetime supply of the stuff and her baby never caught the herpes (that we could tell), but last I heard, the titers for herpes were non-existent in the baby.

I highly doubt this preferential treatment would have been given to anyone else that didn't work on the L&D floor.

Tegaderm for all!

Taking Her Contractions

I was a doula in Frankfurt and had many clients in the hospital there. One of the cool things of the time there (1985-1988) was that epidurals were not an option unless the woman was having a cesarean. Women did just fine in labor without them; it reminds me that women can still do perfectly fine without one now.

Oh, and the word "doula" did not exist in birth at that time. I called myself a "Labor Coach" or a "Labor Companion." I only met one other doula during those years at a La Leche League Conference... I wonder where she is now!

Women were triaged in one room, labored in another, birthed in the Delivery Room (DR), recovered in the Recovery Room (RR), and then were moved to the Postpartum Floor. The Labor Rooms were at least 2 women together, sometimes 4, but they tried not to do that too much. Rarely, women got their own room until the hospital was being renovated and the renovation complete. Even if they had their own rooms, they were separated by a thin wall and there were no doors on the rooms, merely curtains... opening into a hallway where the nurses station was and the nurses and docs sat and yickety yacked and laughed loudly while women labored feet from their seats.

The Delivery Room was an Operating Room (OR) and women were moved from the bed in the Labor Room to a gurney then to the OR table in the middle of the DR for the delivery then to a gurney after delivery and then to another bed for recovery and yet another for postpartum. Lots of butt lifting and sliding; epidurals wouldn't have been helpful!

After the birth, moms got a cursory "bonding time" of about 30 minutes, but that was more theory than practice. More usual was the baby in the Nursery for at least 2 hours postpartum; the time mom was also in Recovery.

So, I have this woman in labor... she is progressing beautifully. Most women were confined to bed, but after time, they got to know me and I was able to get my ladies sitting, standing, etc. as long as the monitors were functioning. I have held more fetal heart monitor electrodes in place for HOURS than any woman should have a history doing. This one particular woman was moaning so nicely... and she was sharing a room with another mom who was not doing so well. After a few hours, the other woman was being prepped for surgery, but I stayed focused on my client and her needs. Her husband was there, too, but scared (I can see his eyes now!). One of the things I love about being around so much birth is offering normalcy to a strange situation for others. He was scared, I smiled, and he relaxed... we did that dance a hundred times that night.

When my lady got to about 8 centimeters, she said she couldn't do it anymore... was just too exhausted. For those of us in birth, we know that she is in the home stretch when she says that, but saying that to a woman who is in that scared place isn't so easy sometimes. I sat with her... face to face... and told her she was strong, that she could do this, that she was doing this... and she began crying. Next to us, separated by a mere curtain, the nurse was reading the waivers for surgery to the other crying woman who was getting ready for a cesarean. Monotone and precise, her questions about allergies, dentures, spinal difficulties, etc. were read and somehow checked in the appropriate box.

My client looked at me desperately. I looked her in the eye and something said, "help her!" and I said to her, "Look me in the eye... let me take this next contraction for you so you can rest" and she looked at me funny, but stared deep into my eyes. As her contraction built, I felt a buzzing of Energy that started in my cunt and radiated outward, through my abdomen (uterus?), through my back, up my spine, into my heart, and pushed tears out my eyeballs. She relaxed more and more with every passing second of the contraction as I let the Energy flow through me... "taking" her contraction.

She was pretty non-verbal during this phase of labor and after the contraction, I said, "That was great... your turn" and she was visibly frightened. She begged me to take one more... just one more... that the rest had been perfect. I told her "Only one more because this is your labor and you need to birth, not me" and she readily agreed and then the next contraction began.

We repeated the same scenario... staring deep into each other's eyes... hands touching... knees to knees... her man behind her touching her shoulders... and the contraction building as she released the Energy into me and I embraced it and loved it for her. The contraction peaked, then subsided and she thanked me quickly and dropped her head and closed her eyes for a moment and then lifted her spirit for her own next contraction. Within 10 minutes, she was pushing her baby out.

In Recovery, she went wild with her astonishment at what we had done. While I was mildly fascinated with the transfer of energy, it wasn't totally foreign; but, new in birth. She went on and on about how she had felt no pain during those contractions, but she knew she was having them... or rather, that I was having them... and she was just so excited!

The monotone nurse from the next curtain came in and took me aside. I thought, "oh, crap... I'm in for it now." The nurse tells me that she used to be a homebirth midwife and she had done Energy Transference many times in labors at home, but she had never seen anyone do it in a hospital. She thought I was the greatest thing since sliced bread. I was embarrassed!

The client heard the midwife/nurse and they began chattering away like birds in the morning on a telephone wire (which are almost obsolete, aren't they) and I had to ask them to please stop talking about it.

I didn't ever do that kind of overt Energy exchange again... in all these years. I'm not sure it was right to do it. I have often sat the woman's SO down in front of her (or her mother if she didn't have an SO there or if he was not a part of the birth experience) and had them do this Energy exchange without saying what I was asking for... I think that the intensity of love can just infuse the laboring woman with belief and power and energy... and unless I am the only choice, I don't really think that is my place. The way she fawned over me was not right; her birth had been hers and I tugged a big piece out of it from her.

Now, can I sit in a room and push Energy towards a mom who is struggling? You bet. Do I? You bet. Do I save some for me? Absolutely. Unlimited giving is as dangerous as not giving at all. Do I know how to replenish Energy from the earth? Ayup. Is it a skill midwives/birth workers/mothers/everyone should know? Absolutely!

While I am glad I was able to help her through her intense exhaustion, I did things differently from then on. What an amazing experience it was, though!

Friday, August 06, 2004

"Let's Just Change Stethoscopes"

I had just gotten to Casa for my second stint there (I had been there in 1993, but returned in 2002) and was just on my first shift as an Intern (under a Certified Midwife). The baby had been born and I was in doing vitals and the kid was clearly in respiratory distress. Tachypnea (fast breathing), retractions (the chest caving in), and nasal flaring (the nostrils spreading wide with breaths)... all signs of respiratory distress when, if left alone, can cause a baby to crash.

I snatched up the baby and took him to the midwife on duty who looked at the baby... took my stethoscope (a Littman, top of the line cardiac stethoscope) and listened to the baby. She heard the rattles I did in this baby's lungs... counted the respirations as incredibly fast... but just said, "Let him nurse, he'll be fine" and pushed him back to me. I was a tad distressed and blinked my disbelief at her.

Another hour went by (I never left the baby's side) and now the child was grunting (audible struggling for breath) and I took him back to the midwife. She took my Littman and listened and then said, "Get me a sethoscope from the room" and, confused, I told her this was a Littman... that she would hear much better with this than the $15 ones in the rooms. She said she knew what she wanted, to go get it. So I did.

When she listened with the $15 stethoscope, she couldn't hear the rattles or the grunting anymore (she said). "That's better! He's fine. Take him to his mom." I couldn't believe what I was hearing.

The baby did get better with time and oxygen (that I begged another midwife to let me use on the baby), but it was frightening watching a baby struggle for breath that way.

I am still amazed at the desire of some people for inaction in the face of danger or necessity... just to cover their butts.