Wednesday, September 29, 2004

VBAC Birth Story - 9/28/04

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

What an AMAZING birth that was, too.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Afterthoughts:

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

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

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

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

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

Monday, September 20, 2004

Sukkah Birth (last night)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I am honored and blessed.