Monday, October 24, 2005

A Baby & a Nap (homebirth)

Sunday morning at 1am, a woman called saying she was a nurse and during her shift, several calls from my cell number came in and she wanted to know who I was. It was from the 714 area code and the only people I know in that area are some of my daughter's "friends," so was worried and called her at 1:30am. She picked up right away and was doing fine. I was relieved. It's amazing how my mind works even totally asleep: daughter's in the hospital, her friends don't want me to be notified and they see the nurse talking to me and hang up on me and threaten her if she calls me again. I heaved a sigh of relief that she answered. That she answered on a Saturday night meant she hadn't gone to a Rave that night. Yay!

I went back to sleep and was awakened again 90 minutes later by my newest client who was also due (she'd left the hospital midwives a week and a half ago because they were squawking about her baby being macrosomic [HUGE], her BP being horrible, blah blah blah). While she did have some BP issues a couple days earlier with me and we spent 5 hours in the hospital getting labs done, all checked out perfectly fine and we left feeling very safe and secure about how well she really was.

We arrived at 4:30am yesterday, set-up while having comical issues with the fishy pool that wasn't blown up yet (including "discussions" with dad and the pre-schooler about the location of the pool - while mom kept insisting on its location even as she labored), and kept busier than usual for a pre-birth ritual set-up because of the pool. Note to fishy-pool birthers: BLOW IT UP AT 38 WEEKS!

The pool, finally blown up, was filled to ankle deep before the water heater gave up all the hot water (and we did ask them to crank the heat up). Mom didn't get in the pool despite wanting to birth in the water; ankle deep just didn't seem so comfortable after all.

We took her BP once before the birth and it was 130/90 - perfect compared to other blood pressures from a few days earlier.

The baby was doing well - the FHTs ran about 120 during the 10 days I knew her, slightly lower at times, including on the monitor at the hospital, but when we heard her starting to grunt a little and I listened, his heart tones of 80 got me to throw a glove on and do an exam to see where we were.

1. Is she pushing and the baby close so we can get the baby out?
2. Is she 3 cm. and we need to call 911?
3. Is there a prolapsed cord (despite membranes still being intact)?
4. Get her to change position.
5. Get oxygen on mom and resuscitation ready for baby if birth is close.

These thoughts and a thousand more flew through my mind in a split second as I did an exam and found her 8cm/80%/0 and asked the other midwife to find the baby's heart tones. While she looked, I felt through a contraction and tried to open her cervix with my fingers - not hard, but it did hurt mom and she said she really wanted me to stop, so I did. The midwife wasn't able to find the heart tones, so I stripped the glove off and found the baby - 60 to 70 now. My mouth got dry and I asked the other midwife to glove and go in to stim the baby. I'm now lying on the floor under mom, between her legs as she leaned on the dining room table. The midwife said she was 9cm, but that the cervix was thick. I moved just in time to avoid drinking the mom's clear fluids as her water broke (coincidence, no pre-knowledge), yet remained on my back under the standing mom. The apprentice said it looked like I was checking the oil in a car because I was not only under mom, but under the dining room table, too. She made me laugh later at that vision. Not something I even considered it looking like.

We put oxygen on mom (all of this happened in a 2-3 minute time frame) and then she wanted to sit down, so we got pillows and sat her on the floor of her dining room and within 20 seconds, saw the baby's head - slightly blue, but pinking up quickly. The baby was born in another contraction and he seemed momentarily stunned, but we didn't suction or need to do any resuscitation at all as he snuggled with mom. We took the O2 off mom and, amusingly, dad grabbed it and put it on his own face! The apprentice was closest to him and was helping him to center as everyone took a giant deep breath and fell into place with their son's birth.

This "macrosomic" baby was 8 pounds 8 ounces and nursed nearly immediately. Her BP went immediately down to 120/80 and was even slightly lower upon departure with the usual reminders about pre-eclampsia occurring postpartum, too, so to keep watching the signs and symptoms for a couple of days. I go back today after school.

Whew.

It was interesting taking someone on so late in pregnancy who hadn't ever had a homebirth before because there was so much to catch up on. For example, it was odd that they were going to take the baby to the lab to do the newborn screen. I wasn't able to explain the why's and wherefore's about why to have the midwife do it (love, gentleness, not having to leave home, etc.), so wrote an email explaining, while also tell them I am not trying to "sell" myself, because I don't make any money from it at all, but that because they would have learned this in the pregnancy and I am merely catching them up.

They are also going to circumcise. VERY odd for the type of family they are, but I also explained about circumcision with a mohel as opposed to going out and getting it done at the doctor's office or in the hospital.

I explained about the 2 week rest period - BabyMoon - and that she wasn't an invalid, but that she was "open" to lots of things besides germs... the mean and sad thoughts of others that can't keep control on their feelings and love to dump them into open vessels - as pregnant, postpartum, nursing, and bleeding women are. (I know she's going to think I'm a fruitcake, but oh well.)

(Postscript: I ended up doing the NBS and they chose to not circumcise!)

Tuesday, August 02, 2005

Brief Synopsis of Twin Birth

Quick nice labor, pushing in the water, head born and then no movement. Mom stood and lunged. No movement. Mom helped out of the pool (watch that head!) and lunge again - no movement. Mom squatted deeply - no movement. Mom helped to lean back, and then back further as midwife felt for shoulder position and baby began rotation. Born 3 minutes after head. He had a nuchal cord.

Baby boy recovered well with stimulation and loving ensued.

I was in charge of listening to fetal heart tones of Baby B, so was right on him as soon as A's feet were out of the vagina. His heart rate was great, then good, then okay, then sad, then scary... so we moved her to the bed and got oxygen on her and the midwife felt for position (and cord) and he recovered within a few minutes.

We waited for contractions to return, mom nursed baby, and then nipple stimulation to bring on a contraction. Pushing began again about 30 minutes after the first baby's birth, but the baby didn't come down so easily, so we got her standing again and she pushed while we waited.

(On the bed, I had to lay on my left side - my horribly painful side - and collapsed at one point as mom readjusted her position and she also fell some - both of us right onto her husband's leg. He was a trooper and barely screamed in pain.)

As birth was imminent, I began photographing again and that's why I have pictures of Baby B coming out, but not A. He did great as he was born - nuchal hand/arm.

More loving happens. Joy! Happiness! Health abounds.

Then bleeding.

Then no placenta despite Angelica and later pitocin. Eventually, manual removal of the placenta is done - with too many clots.

Another midwife sutures as one starts an IV with pitocin.

We clean up the area, stay with mom who's hungrier than I have ever seen a woman be in the birthing time. (She ate about 3000 calories during labor - and continued eating postpartum, even amidst the bleeding.) We ran out of Chux (a first).

The placenta was amazing (as seen below) - Baby A was 8 pounds 8 ounces; Baby B 6 pounds 4 ounces. Baby B's side had a velamentous insertion (see photo below, too), but it all worked out great. The placenta looked rather old, too... very used up. No wonder mom ate so much!

Mom nurses - all seems pretty stable, but she is some weak, but keeps eating and drinking.

We had a CNM, 3 LMs, & an apprentice at the birth. One LM and the CNM left 90 min after the placenta birth. I left 2 hours after that.

I went home and cleaned and sterilized the midwife's instruments and slept during the cooking. I got up, showered, dressed and went back to the woman's home where I found out she'd been to the bathroom to pee, but had been carried there! She had to pee again and was put in an office chair and wheeled there.

Red flags!

Around 6 hours postpartum, she had a slight fever, so another IV was started with antibiotics.

Her vitals were good, then poor, then good again. It was time to go in.

We called EMS (after discussion with dad, mom, then family) and they transported mom via ambulance; the twins went in the car with Auntie (mom's identical twin). Auntie followed me in my car. (Her midwife was so wiped she couldn't see, so I offered to go in for her. She was extremely grateful. Shoot, she'd do it for me!)

Admission went well. Respect seemed apparent, but I have a feeling the staff had an in-service or two about pretending to be nice to our faces - their dealing with us later. Initial bloodwork showed mom's Hemoglobin of 6. With informed consent, mom accepted blood - 2 units. Mom also had a temp again, so antibiotics were started.

Mom and baby were never separated. Yay! She continued nursing well. Peds came to check the babies and they gestated out to 44 weeks (dry, peeling, skinny, soles of feet totally covered in creases, hard cartilage in their ears, etc.).

And she nearly fainted from being NPO while they waited to decide whether she needed surgery or not (manual exploration? D&C?). Once permitted to eat, I saw her tray on the nurse's station and asked the nurse for it. She said she'd have to check first if it was hers. I suggested she find out fast before mom eats one of the mattresses in the room. "Take it!" the nurse said. So mom began eating again. (Mom is a vegetarian and had NO processed food in her home - they ate magnificently. When I put my Diet Coke in the refrigerator I thought an alarm might go off or it be ejected into my face or something. It was to her, and the babies', benefit that she ate so much and so well.)

And they put a Foley in and there was 1600 ml of urine!!!!!! She easily peed that much at the house (an hysterical story all on its own - her peeing), but she was so swollen and immediately began ridding her body of it all.

Once stable and settled, I made sure they were good and left about 3 hours after arriving at the hospital.

Her midwife and I went to the hospital today and they are great. Mom is still on antibiotics, but should be home by tomorrow night.

The babies are so wonderful and loved... and their sisters are missing them lots. It will be good for all to be together again.

Funny, this birth, while twice as odd/scary/fierce as the one 2 weeks ago, didn't scare me nearly as much as that one. Probably because it wasn't my client? Because this family was gushing with respect and kindness? Because the client decided not to transport when the placenta wouldn't be born... because they were comfortable with their waiting... not sure yet all the reasons why.

Processing still.

Interesting that I continue believing that birth works. Talking with others, I watch limitations and boundaries fly up - no more twins! no more long placentas! no more than minimal bleeding! no more dizziness!

Sometimes this is so confusing.

And it wasn't so brief after all.

Thursday, July 28, 2005

Jewish Birth

I was invited to a birth 60+ miles away, as an assistant to one of the other midwives. I'd done one other birth with her and it was really nice, so I knew it’d be great.

This couple was different in that the husband was a Rabbi. They had several other children and had had the other home births with a different midwife, but chose this midwife for a variety of reasons – she is an Observant Jew herself (her preferred term – most of us would call her “Orthodox.”)

Prenatally, I was asked to wear something conservative to the birth. I chuckled inside since I can’t recall any birth where I wasn’t discreet – ever. She mentioned it more than twice. Finally I told her I would be fine, wear scrubs and she didn’t mention it again. I’d planned to wear a head-covering, but lost it along the way (more on that in a second).

I was given a head’s up about her labor, but that I wasn’t needed quite yet. I drove up and was going to stay at my sister-in-law’s house close by, but instead found the house I was going to and then drove to an AM/PM to nap.

I love my Explorer. Pillow, blanket, soft music… I can sleep well. I’d sleep better if I could put my feet up, but sometimes we can’t have it all, right?

I put my sunshades up (to keep the convenience store shoppers out of my sight) and went right to sleep (it was after 11:00pm).

I awoke with a start to screaming and pulled the sunshade aside and saw a man and woman fighting (physically). I grabbed my cell phone and called 911 – along with the other 8-9 on-lookers around me. The fighters ran across the street, leaving a friend/relative in the car (it was running, lights on, etc.) and he got out of the car and took off after them.

While waiting, the boyfriend (?) drunkenly stumbled back covered in blood, sat down on the curb close to my car and the deputies finally got there to talk to him. I never saw the girl again. Or the third person that got out of the car.

I talked to a deputy and shared what I knew, what I saw, who I was – and then the midwife called and said, “come now!” so I had to go. As I drove off, I noticed my scarf had fallen off and now I didn’t have time to put it back on and adjust it properly. They’d just have to deal with my bald head.

I settled myself before entering the home (a combination synagogue/living quarters), went to the bathroom, washed my hands, and then went upstairs.

This was a house. A regular house. In a neighborhood. And it was messy. Sure, there are kids living there, but it was messier than a typical messy kid house. I was surprised. The foyer had a ceiling that surpassed the second floor and as I sat on the second floor’s hallway overlooking the foyer, the ledge across the space held socks, toys, and loads of dust bunnies. Interesting.

(It reminds me of the really messy messy house owned by extremely conservative Christians – this house was nothing like that, by the way – but what happened to “cleanliness is next to Godliness?”) If it was Thursday (before Shabbat), I’d be more inclined to think it wasn’t a typical day, but it was after Shabbat, when major cleaning is supposed to be done.

So, I knock softly to let the midwife know I am there and when a contraction is over, she opens the door and introduces me to mom and dad. I then step back out and sit on the floor in the hallway, reading Weight Watcher’s magazine.

Sweet moans waft through the walls in crests and I hear mom getting closer to pushing her baby into the world.

I know a little about Jewish births. I know that privacy and discretion are important and that blood is an issue. I was comfortable with all of that and was ready to do what the midwife needed me to do.

I heard mama pushing and the midwife talking softly to her, saying she could see the head. The midwife called me in and I tiptoed in, hanging close to see what she would need.

Before the birth, she told me she really likes to do as much of everything as possible unless there is an issue… baby, mama… and I knew this as the baby was being born.

I put gloves on and waited just to her side, sort of behind mom, but dad kept looking at me smiling and saying the most loving and encouraging things. Mom made a comment somewhere along the way that she couldn’t believe she hadn’t even had one vaginal exam – that she’d had several with the other births including a cervical lip being pushed up for a long time with at least one of the births. She said this was so different! So great! And she pushed, without ever being told she was “complete” or that she had “permission” to push.

Her lovely daughter slid into the world, no tears, dad thrilled (I’m not sure where the kids were… asleep? Somewhere else?), and soon after the birth, when the cord had stopped pulsing, it was cut and dad took the baby out of the room so we could quickly clean mom and the blood up so the dad and baby could be with each other again.

It was fluid and easy… not a big deal at all. We washed her feet, washed her hands, I put peroxide on the carpet and towels, covered the soaking blood with clean towels, the placenta was born, her pad put on, she was wiped down once more and then a new cover-up put on, sheet pulled up and dad came right back – maybe 4 minutes? 6? Not much more than that. It was coordinated and easy-going.

I took the instruments and cleaned them for the midwife, gathered up dirty things and garbage and such, put things where they should go, cleaned her doppler, etc. and then thanked the parents so much for the honor of attending their birth, asked the midwife if I could do anything else and when she said, “nope,” I headed back home at about 2:00am (might have been a tad sooner than that).

It was a sweet birth. Quick. Uncomplicated. Respectful. Loving. And another different birth than I’d experienced before.

Tuesday, July 12, 2005

Another UC Story - as written to me

UC birth of an 11-pounder – told to me, then sent to me, and I was requested to keep her anonymous. But, this is her story in her voice. She sent me the pictures to share and asked that I include them with the story.

My second child was a planned unassisted homebirth. How that came about is a long story for another day.

I was fearful tearing at the scar tissue from my horribly managed first birth, and my preparations for this birth included stretching my vaginal tissues with an Epi-No (basically an inflatable sex toy) and taking evening primrose oil and occasionally using it in my vagina as well.

The night before his birthday, I noticed some painless contractions with pressure. This was a new one for me. I was at 41+0. With my first baby, I started labor at 41+2 after feeling first contractions at 41+1. So I was expecting the baby any day.

I slept in the front bedroom (I'd had a bad cold that week and had moved in there) from about 10pm to 4am, a pretty good stretch for pregnant me. I turned on the light and read the fifth Harry Potter book and was just about to turn off the light again just before 5am, when I heard my fifteen month old daughter wake up in the family bedroom. I switched beds.

I had nursed my daughter for about 20 minutes when I felt a RIP SPASM RIP SPASM with a sensation like the baby jerkily pushing on the top and bottom of my uterus at once. I thought I should go listen to the baby with my fetoscope and make sure he sounds good. I unlatched my daughter and started to sit up to get out of bed but when I felt the fluid rushing outward. I took a leap out of the bed to save the sheets from getting wet.

I said to my husband, "I think my waters broke." Of course there was no "thinking" about it. They were ruptured. He said, "Are you sure? What does that mean?" I said, "That the baby will be born today."

I didn't have to wait for contractions; one started as I walked to the bathroom to check the fluid color (I'd been wearing a pre-fold in my underwear to contain any urine leaking from my coughing fits that week and there was nothing to clean up). It was nice and clear. The contractions were those lovely easy cramp ones that just barely hurt. I was very relieved because although I was prepared to wait for weeks if I PROM'd and had no signs of infection, I was just glad that for my first UC things were going the way people "like" them to.

I went into the kitchen to make breakfast for my daughter and my husband got up and tried to adjust both to an early rise time and to the news that he wouldn't be going to work. I carried a chux pad or a towel around with me to sit on. My daughter and I ate eggs and cheese as I eagerly anticipated calling my mom with the news. My aunt and Mom were both staying in town and would come over most days around 8:30 or 9am to help with the baby and the house and be with me. I wanted to call late enough that they would get all their sleep, but early enough that my aunt could plan a day without Mom, because she (my aunt) was not to attend the birth.

I called Mom about 7am. I loved hearing myself say that the baby was coming today.

I listened to the baby once, and his tones were good.

Mom came about 8am and I was leaning on the counter during contractions humming, but not because I needed to yet. I was just having fun.

My husband asked when the baby would come and I guessed by five. He packed up our daughter and went off for a day of fun, starting with breakfast out and then the petting zoo.

I hung out on the counters chatting with Mom until a little after nine, when I decided to get into my hot tub in the borning room I'd set up. This was my private space where no one could enter without permission. Within a few minutes, I was weeping with emotion and singing and dancing in a continuous activity that hit some peaks during the contractions but continued through each space between contractions with the same -- quality. I was singing open, open, open and weeping with the intensity of my ... pleasure might be the right word. Pleasure at being in labor, pleasure at being a mother, pleasure at being alone. They didn't hurt very much yet so I don't want you to get the wrong impression when I describe it as intense. It was emotionally intense.

Suddenly at about 10:45 or 11am, the emotional intensity turned off and I suddenly felt very normal and very sleepy-tired. My contractions, not close together before second stage, seemed to space out a bit more at the same time and I wondered if I could lie down and take a nap. But I hesitated so long each time between contractions that by the time I tried to approach the steps out of the tub, another contraction would hit. So I was tired, somewhat bored and not sure what I wanted to do right then.

Suddenly my mom walks in kind of cheery talking about some phone call she had with her sister. I said, "You aren't supposed to do that! But right now I want you to stay and talk to me." I considered my options and ordered a cheese sandwich and a peanut butter sandwich. She brought them back to add to my poolside table stock of weak Gatorade, water, liquid calcium, cal-mag, vitamin C and Rice Krispy treats (I'm sure there's something I am leaving out from what I consumed in labor). I ate a couple of quarter sandwiches and accepted some neck and back massage while still in the hot tub. It was still not emotional and I was laboring by moving to the other side of the tub when a contraction was going to start and doing my water-labor move -- holding the side of the hot tub and shaking myself forwards and backwards while moaning.

I moan really well and I never suffer while I'm moaning. If it hurts more, I just moan louder and it covers up the pain.

I still wanted a nap and asked if we could move to the living room. I had two identical nightgowns for laboring, one "wet" and one dry. I changed out of my tub gown into my land gown and to my pleasure was able to manage contractions lying on my side on the couch. I dozed in between contractions while Mom massaged my feet and legs.

Before I forget, I want to tell you about these contractions. In my first labor, my contractions felt like a bell curve. In this labor, they were always (once they had clear sensation) 0-90 in five seconds and almost immediately started sloooowly backing off so that they hurt for about I'd guess 30-40 seconds. They were VERY short and well spaced. About an hour before he was born, I think my mom said they were 4-5 minutes apart by my soundings. She thought he wouldn't be born until about 6pm.

While I was lying on the couch, my husband and daughter came home briefly to change clothes before heading out to a restaurant for lunch. Dad put a blanket over our child’s head so she wouldn't see me and ask for Mama, and they rushed in and out.

I spent maybe forty-five minutes on the couch and then decided to go to the bathroom. That was very difficult. My contractions got close together when I tried to do that. It was a challenge contracting in the bathroom and I decided I wanted to get back in my tub. I was going as fast as I can but still had two more contractions before I could climb back into the hot tub. I think Mom was with me to help me change back to the wet nightgown but then she scrammed upon request.

I was back into that emotional place again for about another hour or hour and a half. Contractions were more intense at this point, but in neither of my labors have I ever had “transition.” I don’t throw up, I don’t shake, I don’t say I can’t do this. But during this time, I was only singing and dancing and weeping with joy in between contractions. When a contraction came, I threw myself at the side of the hot tub and just started sounding with all my might so that I didn't have to hurt.

And suddenly, for about a half hour, I left that emotional space like I had late morning and was just kind of bored and laboring. I was quiet, looking around almost bored in between contractions and sounding like crazy during them. And during the contractions, I very distinctly felt my pelvis being pulled open evenly in all directions. Hmmm, I thought. Very interesting. No pressure though. I can't feel the baby pushing on anything. I had been checking myself toward the end but just felt head and a really stretchy, painless womb opening for maybe the last half-hour or hour of labor. I couldn't figure out how to get to the posterior side of the head to feel actual dilation so I just contented myself with exploring my baby and my body.

This is such a minor thing, I left it out of the first draft. Probably five or six contractions before my body started pushing the baby out, I had this thought and feeling "I need to poop and pee and that will make me feel better and that will make the birth easier." It is the same feeling I had the night before labor where I felt right before bed: if I could just empty my bladder I wouldn't feel this pressure with the Braxton-Hicks contractions. But during labor, it wasn’t pressure. Well it might have been, but I would never have said “oh I feel all this pressure” like some women do in their births. It was very subtle. I tried peeing and pooping in the hot tub after a contraction but nothing would come out. I was momentarily frustrated and scared because after the first birth (where I pushed for hours on a full bladder), I wanted to have an empty bladder to birth past, but then I decided not to worry about it and I did not notice it after that. (I think if I had said to a typical midwife, I have to poop, and she had said, “Oh, that's the urge to push. Start pushing,” that it would have been a damaging wrong thing. I also think (now bear in mind this is my first experience of actually giving birth and actually getting to feel a real, full first and second stage), that if I am lucky enough to birth a third time, that since I don't go through transition, maybe that will be my signal to prepare for birthing -- when I get this sense that I want to be empty.)

Then I felt the warning for the next contraction and grabbed the side and started to sound and rock when THE BABY'S HEAD FILLED MY VAGINA. I was like, “OOOOOOAAAAAAAAAAHHHHHHHHHHH MOM GET IN HERE! I WANT YOU HERE NOW!!!!” My vagina went from being empty to being completely full of head in about ten seconds. She hustled in and I told her the baby was coming and, “GET OVER HERE AND HOLD ME UP.” So she kneeled by the hot tub and I put my arms around her body and she held my shoulders and that's how I birthed the head over five or six contractions. The contractions were still short but much closer together and all I could do was hold on and holler. When I hollered, the head moved down. When the contractions were dying down enough for me to stop hollering, the head stopped moving. His head was way outside my "body" before he was clear of my perineum. It was so wonderful because it felt SO right and I knew I was not going to be harmed. I didn't have to push; my body would do that for me in this very mysterious, perfect way.

On the fifth or sixth pushing contraction, his head finally cleared my skin. I would say this was about 10 or 12 minutes into second stage, since these short pushing contractions were frequent. I recall being able to have short conversations with Mom between contractions, four or five statements apiece, before he would start moving down again. I remember as his head was being born, there was no pain in between contractions as long as I did not move. At one point between contractions during the birth of the head, Mom asked me if we could move a foot to the left so that she could kneel on the steps (that's right, she was being forced to stand during contractions to support me where we were) and I tried, but cried out, “stop!” because it hurt. But with my body suspended in water and not moving, I was completely comfortable in between contractions.

I told Mom that the head was out. My eyes were closed and I backed away from Mom a bit and sat there in the water. I reached down to feel his head, located the landmarks of his face and felt him, willing him to start rotating. He stayed face backwards, not moving, not moving ... slowly he started rotating. He made the turn toward my right thigh. Good baby. I went to feel around his neck for curiosity's sake. My intention ahead of time was to leave nuchal cords alone.

Two loops of cord ... um, I don't feel a pulse here. It never occurred to me that that would be the situation so it affected me differently than it will in a third birth. I didn't like it.He had moved once during his head birthing, so I wasn't too scared but I wasn't happy and decided to try to do something. I believe I referred to this in the early postpartum period as my attempt at Stupid Midwife Tricks and I still do not know if I was doing the prudent thing; being benign but ineffective; or causing some type of harm or some combination of these. I just want a nice pink baby next birth.

Or purple, that will suit me too.

Just not white.

I do think that my activities probably slowed down the arrival of the next contraction. But since in my experience, delayed contractions hit harder, maybe that worked out for the best. He was a big baby.The first thing I did was tell Mom what my concern was and turn around and present her with my behind so that she could reach him underwater and I asked her to unloop the cord from around his neck. I was thinking at the time that this was "doing something" and maybe the cord would get moved and whatever was causing it not to pulse would be somehow changed.

She unlooped his cord and I felt it. Still limp. I decided to get out of the hot tub.

This is what I remember after I got out of the hot tub. I have thought about it, and I think this is complete and ordered. I remember getting on hands and knees facing the wall, and asking Mom to suction him with the bulb to see if that would make him start breathing while he was still inside me. I knew this was not a shoulder dystocia, but I remembered reading that sometimes when shoulders are sticky the baby will (not often, but sometimes) be able to start breathing on the perineum, which takes the time pressure off. And what I wanted was breathing baby. He made some mews of irritation probably right before losing consciousness. (This was really a bad experience for him and when he loses it entirely, I sometimes think he is remembering When the Bad Thing Happened). I hoped that meant he could breathe. I asked her if he was pinking up. She said no.

I got up and went to the side of the hot tub. I remember holding on to the edge of the hot tub and doing some squatting and kind of shaking myself to see if he would fall out. I remember trying to push in this position, but I had no idea how to push consciously and I felt I was not being effective and was just going to hurt myself.

I went back to hands and knees and asked Mom to see if she could -- (remember I am not a midwife) but what I was remembering is pictures on TV of babies with their heads out and the doctor has his hands all over the baby and is kind of pulling down on the baby's head with the mom supine and the baby slides out. I didn't want his head pulled on but I asked Mom if she could put pressure on one of the shoulders to see if he would come out. She went in and said, "I can hook an armpit." I said "Give it a little pull" knowing my mom never forces anything (from early childhood, my parents constantly told me not to force things or I would break them). She did and I said, “OW STOP.” I think this is where I got my skin split because I don't remember anything hurting the wrong way but this, if you know what I mean.

I think I decided I would climb some steps and see if he would fall out. I am not sure where I got the idea that he might fall out, but I was ever hopeful.

I was just about to walk through the doorway to leave the borning room when the next contraction hit -- I suddenly dropped forward to the floor without thinking and out he came. Mom said something cheery like "There it is!!!"

I was slightly lower than hands and knees I think, but it happened very fast. I turned around, scooped him up off the floor and started talking to him and rubbing his back and patting him. I had him stretched out lengthwise on the air mattress on the floor of the borning room. I was kneeling next to him on the floor thinking these thoughts: Oh dear, he is white and floppy. Oh my, he's big. Oh, look at that penis. Oh, look at my beautiful baby. I kept rubbing him briskly and I said, "Come on little boy." Mom said, "It's a boy?" surprised because she thought he would be a girl.

He stayed white and floppy with his eyes closed during this vigorous rubbing, turning over on my arm, and more rubbing and talking. I ended up giving him three lungfulls of air before he started screaming and turning bright pink.

The placenta detached while I was kneeling there because that's where the blood puddle was. I didn't notice this at the time because I was so busy working on him.

I moved to the air mattress and sat there holding him and rubbing him and trying to comfort him with the breast. I took off my nightgown, naked for the first time but not worried about being powerless now. I held him to my bare chest. He kept screaming. I said I wanted to get into the tub and see if he would relax if I put him back in the warm water. Mom helped me and then I asked her to go call my husband.

I heard her from the kitchen saying, “Congratulations you have a son!” She came back into the borning room and said, “He is three minutes away. They are just leaving the playground.”

My son was born at 3:20 pm

He kept on crying in the hot tub.

My husband came in holding our daughter and trying to get his bearings. The baby was still screaming. He said I should get out so the baby wouldn't get cold. I didn't want to argue about how 90% of his body was in 94-degree water, so I got out and got on the air mattress and covered us with the comforter.

The baby still wouldn't nurse and I wanted to use nursing to help with third stage. So I asked my daughter to sit next to us on my left side and nurse. She hesitated and then nursed for a minute just staring at her brother crying hysterically in my right arm and then burst into tears. The squalling baby was getting to be too much for me, too.

Our daughter went back to Daddy and I lay on my left side and tried to nurse him again. I asked mom for my cell phone and left a message (complete with screaming baby in the background) with an understanding midwife. She didn't answer so I tried another friend. She didn't answer so I hung up and just stared helplessly at my distressed baby and cuddled him and talked to him and tried to nurse him and willed him to please stop crying. I picked up the phone and called the midwife again. She answered this time and I told her he was born and probably a little about it, but mostly, "He won't stop crying! Why is he crying?" She said something like, “Sometimes their collarbones might break on the way out. Be careful with his arms.” And hearing "bone" "break" I said, "OK YOU CAN COME OVER NOW." (She'd said earlier in the week, "I don't have to wait three days or something to come see that baby, do I? I'm special, right?” And I said, “I don't know. Maybe, maybe not.”) And she chuckled and said she would be by later in the evening after registering her team for lacrosse league. So we chatted a bit and rung off. I told her he was a big baby.

Shortly after that, my husband made another you-should comment (I can't remember what it was, but I think it had to do with warmth or cleaning off blood or “why aren't you nursing him?” or something like that in an effort to be helpful in the face of a naked unassisted birthed wife and screaming baby) and I said, “You all need to leave me alone because I still have to birth the placenta without bleeding to death. I am going to go into the bathroom where we can sit under the heater in the ceiling.” So I did. And it was lovely in there and after maybe a total of three crampy postpartum contractions, I had an urge to lean over from a standing position and release the placenta, which fell painlessly to the floor.

He stopped crying around this point and was alert for five or six more hours, but really wouldn't nurse.

I called Mom in and asked her to hold the baby so I could take a bath and clean off. She sat on the closed toilet holding the baby in a towel with the placenta lying there on the floor. I hopped into the bathtub and took a quick bath. Within a few minutes, the baby and I and the placenta in a bowl were snuggled into bed. Mom brought me the rest of the labor sandwiches, relatives were called, my daughter came up on the bed to snuggle and nurse, and my aunt came over from the bed and breakfast.

I cut the cord at 3 hours under pressure from the family. At about five or six hours, I replaced the cord floss with a clamp because blood was leaking onto his blanket. When I clamped it (still four or so inches down the cord) in front of the floss, being very careful not to pull the cord, he SCREAMED. I won't be interfering with the cord on my next baby unless I have to for his safety until it is hard and dry.

I was getting tired and wanting to go to bed so I called the midwife to find out if she was really coming. She said she was on the road on the way so we stayed up a bit longer. Mom and my aunt left for their room, taking comfort in knowing that the midwife would be stopping by as an extra layer of "everything's good."

I was in the big rocker cuddling a sleeping newborn when my husband let the midwife in. She came up, eager to see him and I said, "He's a big baby." She asked to hold him and I handed him over. She said, “oh my, he is big ... oh my.” She put him in the sling for her scale and tried to lift it while sitting on the couch, but she couldn't. She had to stand up. Eleven pounds even.

You know, I almost always wanted to do for myself in this pregnancy. But at the very end of the pregnancy, I wished for (but never pursued) someone to give me a prenatal because I was tired of looking after myself. And after my son was born, I just wanted to partially hand over responsibility for things to someone else so I could just hold my baby and not feel guilty for not scrutinizing him. I wanted someone else to put a diaper on him and dress him. The midwife gave him a barebones newborn exam (he did not have a broken clavicle) and visited for a while before leaving us to sleep for the first time as a family of four.

After being woken and unwrapped and then dressed, my son was mad enough to do a first good nursing. But as I realized over the next two days, there were no really good nursings. He was tongue tied so eventually I gave up on stretching it and convinced the midwife to notch it for me when he was about 10 days old while I held him in place (harder on her than on me). His nursing improved immensely after that and he started catch up gaining.

And that is the story of the birth of my son.

Barbara asks:

Why wasn’t your husband there?

Birthing woman answers:

He wasn't there because his role in the birth was to mainly be helping with my daughter while my mother mainly helped me. For example, we discussed in a transfer my mother going with me while he went separately with our daughter, gathered up diaper bag and so forth and then gone and done insurance stuff while my mom stayed with me. It wasn't planned ahead of time that he wouldn't be in the house, but since I had gone into labor first thing in the morning, on a beautiful day, it seemed natural and appropriate that they go off together since my mom was there for me. I found it very peaceful to have the house empty. Had I given birth a few hours later, he might very well have been home. But when we discussed things ahead of time, he did not want to be in the room (our first birth was a rape, which I’m sure affected him in this matter). And I had a strong rule that I was not to be outnumbered at any time while birthing.

Barb asks:

Why didn’t your husband dress the baby instead of the midwife?

Birthing woman answers:

My husband will hold tiny babies, change babies diapers and clothes as asked, and so forth but he feels very unsuited to handle them until six months or so and before that he is afraid of their fragility or having them cry and he can't help. I left my son swaddled naked until my midwife friend got there, since she was going to look him over for me and I didn’t want him to have to dress, undress and dress again; and since I was not feeling like dressing him it seemed natural to impose upon her to do it. I did want him in a diaper before I took him to bed.

Barb asks:

Why don’t you consider this a shoulder dystocia? In your description, by every indication and sign you describe, it was a shoulder dystocia.

Mom answers:

This is a hard question for me. You’re the first to call it that, though I’m sure not the last. He was not turtling, he did rotate and when I talk about waiting for rotation, well he didn’t rotate immediately but he was a watched pot. I’ve just counted one-onethousand, two-onethousand … with my eyes closed. Remembering. Five to seven seconds passed before he started rotating. It only felt like forever. Time passed SO SLOWLY, and he birthed easily and in reasonable amount of time after the head was born. 90 seconds, two minutes? It felt like a long time between the head and body contractions, but I was moving quickly between those activities so it was just my perception.

I did not ever feel resistance on my pubic bone. The head didn’t come fast but I was holding back power while birthing the head. When I did get a contraction he slipped right out immediately without any voluntary pushing on my part. My sense, during the period when I was trying to get him out without a contraction, was that I had time to try to do it without hurting myself. He was mewing when Mom suctioned him, for example. There was a point where I would have started pushing like crazy with her pulling and I was almost there because I was running out of ideas and time seemed to be passing slowly; stairs were my last idea. But it didn’t come to that.

If I birth again, I don’t know. I’m still working out lessons from this birth.

You know, after writing all of the above I did a web search on “sticky shoulders” and found this:

Excerpted from http://192.220.73.80/archives/shoulderDystocia.html#Difference
At midwife deliveries (which amount for about 80% of births in my unit ) the shoulders are delivered by maternal effort and force of contractions in most cases. Typically there is a lull in maternal effort and uterine contractions after delivery of the head. The next contraction typically doesn't come for 90 -120 seconds. By the 60 sec definition almost all of these normal deliveries would be defined as shoulder dystocia, this must mean the definition is inappropriate.

Note from Barb


“Turtling” is when the head is born outward and then is sort of sucked back inside… a classic sign of shoulder dystocia.

A short note from mom says:

I would like to make sure the message is heard about how amazing my mother is.

Note from Barb

I have heard wonderful things about her mother’s presence and presence of mind during the birth a number of times. I know this birthing mom was very blessed to have her mother available to nurture and witness her own daughter during her daughter’s child’s birthing.

UC loss - as told to Me

July 6, 2005

A long day.

I met with the woman who lost her baby during her UC today. It was emotional and painful for both of us; her to share and remember – me to hear.

She said I could blog and share her story where I felt it was important or could be heard. I will work hard not to dramatize what she said, either, but parts are dramatic and painful. And scary if you are pregnant, so you are forewarned.

We sat in my back office and I just sat and let her talk. She said she cried all the way up to see me and didn’t want to cry right away, but both of us did. I hugged her hard when I saw her in the hall, before walking back to the office. At times, it seemed right to touch her. Others, she felt inside her own space and I tried to honor that.

Nothing was linear, so writing it probably won’t be either.

After she talked for a few minutes, I wanted to touch base with her physical recovery. She continues bleeding (not unusual at 4 weeks, especially since she isn’t nursing). She took care of her milk production perfectly… with sage, ice, no pumping. It was horrible for her when her milk came in. I can’t even imagine. She didn’t tear, but she still feels twinges in her belly and vagina. Again, I reassured her that that is normal. I shared that she might “feel” the baby kick sometimes… she said she does (and cried).

She feels empty. Defective. Much of our talk revolved around her NOT being defective at all, but normal. Her body worked perfectly. I shared my experiences of other labors and births – she wanted to compare her labors and births to her family’s and friend’s… apparently they all had easy births that got easier with each baby. I reassured her that not everyone gets that. I didn’t! I reassured her that her body is perfect for birthing. She described horrible back pain (posterior babies?) and I let her know that some women do get that, too. She wanted to know if her attitudes and feelings during the birth were normal. She cussed and hollered in places… why doesn’t anyone else do that? Laughing gently, I told her that she was sooooooo normal! I think she felt better knowing she wasn’t the only one screaming FUCK in labor.

She said until today on the way up she couldn’t remember why she wanted a UC in the first place… and then she remembered.

The midwife she had during her first birth (not in California), while kind and friendly, ignored her birth plan during the birth – broke her water without permission, did extremely painful vaginal exams even after being told she didn’t want them, made her push on a cervical lip for a long time before the baby was even ready to come down, and kept her on her back. The midwife also brought an apprentice that S went to school with and S could not stop thinking about being naked in front of this person who knew so many of the same people. She said it was so hard to stay in the labor and birth – something she wanted to do so badly… and had planned for so hard. The midwife made comments that hurt… and laid her head down during pushing as if she had given up on S – S herself said she then gave up on herself when no one else seemed “there” for her. The midwife and apprentice kept talking about stuff during the labor, too. Nothing to do with S’s labor and birth… just life stuff. S said she tried to be a compliant patient and didn’t say, “shut up!” to them. When S got to the cussing, noisy part of labor, the midwife told her she was being too loud… SCARING HER BABY! (emphasis mine) She said her thought was, “Great! The baby isn’t even out yet and I’m a bad mother!”

She saw the midwife after the birth… took her baby to see her. She said she doesn’t have terrible feelings about her or anything, that she is human and was probably doing what she knew to do, but it wasn’t what she needed. So, she decided to UC instead. She removed the variable in the equation – the midwife.

As an aside, I asked her to please consider telling the midwife her feelings and experiences. She doesn’t have to now. She doesn’t have to over the phone. She can write her whenever she is ready, but that unless she tells her, she will never know and never change. This feeling I am going to share is confused with a lot of other ones, so it might not come out so graceful. I feel that midwife is at least partially responsible for that baby’s death. That if she hadn’t hurt S, S might not have chosen to UC. Sure, I know, the baby might have died anyway. There is no telling if anyone or anything couldn’t have kept that from happening, but what if? Even staying away from the culpability aspect, the midwife still should know that she hurt a woman’s spirit.

So, her labor begins and it’s 12 hours from beginning to end. Nearing the end, she thought about calling a CNM friend, but knew she wouldn’t be able to come (for professional and personal reasons) and thought about calling me, but thought I wouldn’t even remember her. I told her I’d thought of her often and would have known and come immediately. That made her cry. Me, too.

The baby moved throughout labor, reassuring her as to his health and well-being. She had been in fear during the first birth with the midwife – had zero fear this time. She felt safe and that all was great. Her husband was there and her 3.5 year old daughter was in and out once she was awake. She pushed for about 45 minutes (if I recall correctly) and her membranes were intact. She said that they presented… a huge bubble of water that her husband thought was the head… and she knew, finally, she was nearly there. She gets extremely tired at the end of labor, as most women do, and thought maybe she didn’t have what it took to push her baby out… that maybe she was abnormal that way. Not at all! Many, if not most, want to sleep and certainly a lot of women fall asleep in-between contractions – some even snore! – during the end of first stage and in second stage.

She wandered around, in and out of the water, leaning a lot as she labored with her major back pain. When she was pushing, she was in a standing squat… not terribly deep, but not standing straight up either. This is how the head was born.

She said that with her first, the head was born and the midwife told her to just wait for the next contraction to push again. A couple of minutes later, the contraction came and she pushed her out. This time, however, the head was born and then there were no contractions at all.

She felt the baby moving and looking back, she believes it was probably the last movements that occur as a baby suffocates/strangles/loses his/her oxygen… fast and hard. At the time, she felt, “oh, he’s moving!” and felt reassured as she waited.

Her daughter, watching the rare tv show, all of a sudden cried out from the other room… just as the baby stopped moving.

S said that in that moment, she began doing stuff to free the baby. She squatted, she went to hands and knees, then she lunged at least once… doing everything she knew to do. She then flopped onto the floor, butt flat, and pushed with her entire being as her baby came out. His head was purple. His body “perfect.” (I asked if his body was white… she just said he was perfect in her answer.)

She didn’t tell me minute by minute details, so some is missing as I re-tell it. And that’s okay.

She rubbed him up, but he didn’t respond. She tried rubbing him harder and he still didn’t do anything… no breath or anything. She remembers knowing something was very wrong and started doing mouth-to-mouth on him. Somewhere along the way, she told her husband to call 911. I don’t know where the daughter was in all of this.

She describes the EMS firefighters as they came in – all huge and yellow (as SO many women describe them!) – and she was on the floor naked and so was her baby. They asked her lots of questions as they began CPR on the baby… she stopped mouth-to-mouth when they brought the ambu-bag in. They wanted to cut the cord, but she said not until it stopped pulsating. She doesn’t really know if it was even pulsating at that time (I suspect not). She said that it was all in slow motion. As they worked on him in front of her, she focused on his fingers, staring at them… memorizing them. She looked at his ears… saw that one was folded over just like her daughter’s. She felt how soft he was. They asked again about cutting the cord and she said okay – she just wanted the baby to be okay, so one firefighter did cut it with a scalpel.

Questions – did you have a midwife? Answer – I was my own midwife. Question – Did you just feel the urge to bear down and come in here? Answer – No, I was in labor.

The husband was being questioned by 4 police officers in the kitchen. She said pretty much she answered all questions with “I don’t know” while her husband answered all questions he was asked.

Sarah, my cop partner, said UCers should practice “I don’t know” and “I want to talk to my lawyer” and NOT SAY ANYTHING ELSE except your name to law enforcement. S did it perfectly.

So, they are taking them both to the ambulance – they are still working on the baby – and she reached out to touch her baby’s hand and she said he was so cold! She was upset because he wasn’t covered and despite her extreme modesty, she pulled the towel off of herself and covered her baby, tucking it around him.

The ride to the hospital included listening to the EMS people talking to the hospital, confusing the story – saying she did have a midwife but they couldn’t find her, that she was wedged in-between the sink and toilet (she said that was stupid).

Once at the hospital, I think they took her one place and the baby to NICU. She said that later (45 min after the birth – 15 min after entering the hospital), they took (wheeled?) her down to the NICU to show her how they were trying to make her baby breathe. A very young doctor, matter-of-factly said something to the effect that “it has been a really long time that they have been trying to help him breathe and that it was unlikely he would respond… and if he did, it wouldn’t be a good thing” (something like that).

I don’t know if she watched them stop working on her son.

I know that her husband, who doesn’t cry much, cried as he went to hold his son for the last time.

I don’t know anything (yet) about her holding her son for the last time.

During another part of the talking with S, I asked if she had the picture the hospital took of the baby. She looked at me completely lost. I said, “Didn’t you get a picture of the baby?” and she said she did not. “Did you get a lock of his hair?” No. “The blanket he was in?” No.

I thought I was going to throw up. I didn’t tell her how angry I was that they didn’t give her these things. Even the towel she tucked around her son was thrown away. She has nothing but his ashes. To me, that is just wrong.

S said it took a long, long time before she realized he wasn’t going to breathe. She kept thinking, even at the hospital, that he would just wake up and breathe. She said it was so weird how it came over her that he wasn’t going to wake up.

And a lot of that happened during the time that they were all over her to deliver her placenta. It isn’t unusual to “cling” to the placenta as a child is dying (from my experience and what I hear from others)… or, conversely… to have a hemorrhage, especially after the shoulder dystocia. She knew if she didn’t deliver the placenta, they were going to poke her. So, she told the placenta to come and it did. They shot her in the arm with pit anyway.

And then, they wanted to take blood and start an IV and poked her TWELVE TIMES before getting the blood and IV started. At 4 weeks postpartum, she said her arms just now are un-bruised. She couldn’t even move her fingers afterwards from so much pain.

They dripped pit in the IV, too. She said at that point, she didn’t care anymore what happened. She wanted to die. Her daughter lay next to her on the hospital bed.

I know that she went home around 12 hours postpartum. During the stay in the hospital, she had to talk to the police and social services. I think she said the police came to the house again, too, afterwards, but once they answered the questions, they haven’t been bothered again.

(Sarah said that had they had a different group of cops, they could have made it evil for her… taking her to the Women’s Jail… just making things very difficult for her. Blessedly, everyone that she had contact with were decent enough. Even the doctors told her that babies die from shoulder dystocia in the hospital or with a midwife… and that no one wanted to make her feel guilty, but they just needed to ask a lot of questions. CPS has had no contact, as far as I know, with the family. If they haven’t come by now, she can breathe easily.)

I don’t know when they had their 8 pound baby cremated, but dad went to pick him up.

She said she has a new respect and love for her husband who has been nothing but incredibly loving to and for her. He holds her anytime she needs it.

Her daughter is working through things herself. She wanted to leave the hospital, saying, “Let’s get the baby and go now” several times. She asks about the baby, says she misses him and such. Mom seemed confused about how to deal with her questions and feelings, so we role played a little about how to address her worries and feelings while also honoring S’s feelings. I encouraged S to sit with her daughter and ask her what she remembered of the event… and then ask her if she had any questions and to answer them. I encouraged her to cry… with her daughter… and that if she was crying and her daughter wanted to know why, to be honest and tell her. Not to hide it in the pillow. Her daughter saw a pair of scissors and asked if that is how daddy cut the cord… S didn’t know what to say because EMS cut the cord. I told her that would be a great way to jump into the discussion… and it will happen more than once.

I reminded her that her daughter doesn’t have the emotional or linear ability that adults do to put things in context. That her thoughts and worries will jump out like firecrackers, sometimes at the most inopportune times, but that it is great that she trusts enough to speak out… and she needs to so she doesn’t eat it up and swallow it, trying to take care of mom and her feelings. “Don’t Feel” isn’t a good way to grow up.

We talked about self-care. She feels so empty. She isn’t pregnant or nursing and she is such a good mother! It’s what she does best in the world she said. I reminded her that it is time to mother her Self for awhile. That this is a moment of practice for when all her kids are grown and gone and she is still left with her Self.

I encouraged her to find something interactive to do with her daughter… pottery, or swimming, or something… not just driving her somewhere and dropping her off.

I encouraged finding space and time for dating her husband when she is ready.

She asked about having another baby… when? I said that physically she could probably conceive about 3 months postpartum, but that emotionally and spiritually, she should wait until she was ready for THIS baby to come… not as a replacement for her son who died. (She’d already told me she wanted to have another baby because she felt incomplete.) I told her how this was so not like when people have a dog die and go out and buy a new one to replace it. This is more spiritually important. That she cannot foist the wishes and dreams for her dead son onto the new spirit to be. She said she understood, but I suspect she will be pregnant sooner than later.

S has asked me and another midwife (a CNM) to attend her next birth… to keep our hands off, but be there if she needs us. When she spoke about no fear at this birth, I asked how she would feel next time. She said she wants to have no fear! I beamed with joy to hear her say that.

Then she also said that once the head is out, she will push with her soul even without a contraction. She didn’t care if she tore everything, she would push her baby out. I gently explained that it was important to allow the baby to do his rotation, too, but that if her instinct led her to push, then, by all means, do it!

I’m putting her in touch with my friend who was birthraped on the east coast. They have so much in common. I sent her home with her phone number. I am also going to find a group for her of parents who lost a baby during late pregnancy and birth and right after. She doesn’t know anyone. I want to also put her in touch with the other UC moms I know who lost babies.

Of course, I told her she could call me anytime… at any time… even just to cry and be heard.

I can’t even imagine her pain. She said she can’t either. She tried to quantify it… comparing it to moms who lost their babies in pregnancy or later. I told her there was no measure for sorrow… that each person has their own horror to tend to… and trying to wonder if someone feels worse than you is a waste of your healing energy.

I shared with her about how Judaism teaches that there is a full serious year of mourning. How our culture says, “take a week off” and then back to business. But that is so unrealistic. We talked about the Stages of Mourning… and how they overlap and superimpose on top of each other… over and over… for a long, long time. Not to set a time limit on her sadness… that that removes a level of stress to try and conform. (Like labor.)

She kept a blog for awhile, but felt there wasn’t the support she wanted on-line, so logged off in November 2004. She went back last week and emptied her emailbox to start over. She went and read her blog and wrote about how tired she was and how her body hurt already… complaining about the pregnancy and what it was doing to her body. A yoga friend of hers said to her, “You call that suffering? Imagine if you lost a baby! Now, that would be suffering.”

And that is how her blog ended.

So horribly prophetic.

I feel so honored to be a part of S’s process. I feel compelled to tell the midwives around me – ALL around me around the world – why she chose to UC. Is that using her sorrow to press my agenda? Probably. Is that okay? I’m not sure yet.

I don’t want to say that all women who UC have problems because, for goodness sake, most have beautiful births! But, can’t I use her birthrape (her word, without my prompting) and the other birthrapes out there as an impetus for change because women continue choosing UC because of their previous experiences?

I’m so confused. And so, so sad for her.

I’m glad I could hold her for a moment.

Sunday, April 10, 2005

Aimee's Birth (Part II)

For those just beginning this story here, Part I is right below this.

As I stepped out of the car, umbilical cord dangling with a forceps connected to the end, I plopped down into the wheelchair and heard applause. Looking up, I saw a man on a balcony across the parking lot and he was hooting and clapping. "What was it?!" The nurse and I in unison - "a girl!" Woo hoo!! I started laughing at the absurdity of having a baby in the car. I had no concept of the mileage it would have over the years. I teach my students and clients that if they have a baby in the car to not be worried at all... that it is the coolest birth story forever.

The teeny nurse started pushing the wheelchair towards the ramp that led to L&D, but right off the street/asphalt part, before the ramp, there is a 1/4 inch step-up and the chick hit it... hard. I was knocked out of the wheelchair and stood there laughing, umbilical cord tick tocking between my legs, the clamp brushing my calf. I told her I could walk up the ramp perfectly fine, but she insisted I sit, so I did. I couldn't wait to see this.

As she pushed me up the ramp, she was nearly horizontal. I just laughed at the situation and swear she put oxygen on her face when she dumped me into L&D's hands.

I was wheeled through L&D, past the Newborn Nursery where Aimee was in the warmer and right into the Delivery Room. I hollered for them to bring me Aimee as I flew past the Nursery and they said she would meet me in Recovery.

Spouse tells me that when he went into the Nursery (he went in when the gang left me in the car - per my instructions), they grabbed my birth plan and the Nursery staff stood next to her in the warmer, ticking off what they were not to do. Bath? Nope. Erythromycin? Nope. Vit K? Later. etc. They were lost. And I loved hearing that.

In the Delivery Room (and for those confused about all these separate rooms, it was like that - a separate place to labor, usually a room for two women, separated by a curtain; a Delivery Room that doubled as an OR; a Recovery Room where women spent about 2 hours postpartum... until they peed, usually; and then the Postpartum floor where they stayed 3-4 days for a vaginal birth and 6-8 days for a cesarean), I sat alone in the wheelchair. I felt the placenta let go and started a great contraction. I hollered that the placenta was coming. No one heard but the echoing walls of the DR. I stood up and out plopped the placenta, right into the seat of the wheelchair. I stood there and yelled, "Placenta's here!" and Mark came running back in saying something about, "Can't I please give you a shot of pitocin?" blah blah "precip" blah and I said, "Nope" and reached under my dress and did some self-nipple stimulation. I barely had any bleeding. I didn't think to tell him that I'd been in labor for quite some time, I just didn't come in. I did not precip.

Mary Carol, my CNM, had said she would come in for me even if I had the baby not on her shift. However, when I delivered in the car and they called her, she laughed and said she'd see me in 3 days instead.

I was put into yet another wheelchair and moved to the Recovery Room and met spouse who had Aimee in his arms. I jumped into bed and touched my daughter for the first time on the outside. An overhead warmer was put over both of us and we were toasty within moments. I don't see these warmers anymore, either. All I see are the warmers attached to the isolettes in birthing rooms. Those overhead warmers were the best for keeping moms and babes together when a baby was slightly chilled or having some breathing issues.

I unwrapped her to look at her. My friend Kathy got there and we told her the story, laughing the whole time. Aimee had a brown spot on her left knee and I asked the nurse if it was a birthmark. She asked me what I thought it was... and I said, "I dunno, dirt?" and she laughed asking if I dropped her on the ground out there. Nope. Beautiful brow birthmark she carries on her upper knee to this day. I never see it without thinking of her amazing birth.

We nursed great and things were so fabulous, the neonatologist on said we could go after 4 hours postpartum. Then he came in at 3 hours and said that if she got the Vit K, we could go. Do it!

I was home 3 hours and 10 minutes after leaving.

Spouse went and got the kids while I called Heide, the German midwife, who came rushing over. When the kids were there, Heide checked Aimee from head to toe and chided me for not calling her when I was about to deliver. Confused, I said, "I thought you couldn't keep me as a client?!" and she said if I'd have called, she would have come. Dang.

So many other things to share. I had a really hard time nursing Aimee; she sucked on her lower lip and it wasn't discovered for over 2 weeks. I tandem nursed and that was really difficult for me, but I made it.

Besides the beauty of having another child, when Aimee was 2 days old, I went to a La Leche League meeting and met Sarah, the love of my life. Sarah'd heard about my cool birth, my fabulous birth plan, and came to the LLL meeting especially to meet me. It was there I met another woman who watched Aimee be born and told me the story from the inside of the hospital. I loved being able to have the story from several locations! I was with my baby girl.

I still laugh... am smiling writing this... it was such a great story to live. And even more fun to tell!

Aimee's Birth Story

I was nursing Meggie and hadn't had a period since her conception. I had a feeling I was pregnant, but test after test showed I was not. I went to see a German midwife and her bimanual exam couldn't find a baby either, so I went to the military docs. I saw the black male doc that I despised; he was evil to women in birth and I suspected really hated fat white women. He did a bimanual exam, too, and found nothing, but, at my insistance, ordered an ultrasound. The ultrasound a week later didn't find anything either.

I was stumped.

I began feeling movements, but with Irritable Bowel Syndrome anyway, those movements might just have been gas rumbling around. You'd think that with this being my third time I might know better, but I was just as lost as the first time. Perhaps more so.

One morning, I was lying in bed nursing Meghann. And dang nursing hurt! I kept thinking, for months, that I had thrush, but her mouth was clear. My nipples just hurt like crap. My LLL leader friends questioned invisible thrush or invisible pregnancies - perhaps I was delusional? Wouldn't be unheard of.

So, lying in bed, I watched my intestines rumble so good I could see a leg sweep across my very fat belly. I poked at my then-husband to show him my non-pregnancy in action. I told him, over and over, I was pregnant, but he didn't buy it since all the tests and ultrasound and docs and midwives disputed it. I was never more sure. I told him if that wasn't a baby, he best just schedule a surgery to remove an alien dancing tumor or something.

That day I went to the PX and bought another pregnancy test and I held my pee the whole time. Lo and behold, the line jumped POSITIVE that time.

My wonderful midwife, Mary Carol Akers (where is she?!) ordered an ultrasound and they found a baby 20 weeks along. Where had it been hiding before?! Probably behind my fat. By my calculations of intuition and fetal movement, I was only 16 weeks or so and told Mary Carol I was not going to be induced if they thought I was late; that I knew s/he wasn't going to come for another few weeks. She laughed and said we would deal with that if the time came to discuss it. It didn't. The ultrasound was pretty right on.

My "due date" by that late u/s was April 18. She was born April 20.

However, an unexpected "complication" occurred as my membranes ruptures on April 13.

I was going to have another homebirth (Meggie was a UC at home), but with a midwife this time. I'd found a German hebamme (midwife) and I liked her lots! Heide Korner (with the double dots over the O in her last name) was the teeniest of women. She'd had two cesareans herself, but had caught over 500 babies at home, over 1500 in hospitals. She was a delight with her heavy German accent and not all the American words needed. We were still pretty darn poor, but paid her what she asked for because we so wanted a homebirth without the drama of EMS and CPS like we'd had with Meggie's birth.

When my water broke - and it broke with a huge gush and kept dripping - I called Heide (High-duh) and she came over agreeing that it was, indeed, my water. I knew that. I had no contractions at all, so after about 12 hours, I started doing all the aggressive things we know to do to invoke contractions. I was already nursing a 23 month old, couldn't have intercourse, have a hard enough masturbating not pregnant, so orgasm was out of the question... castor oil was the next line of defense. Ick.

Many years later, I learned to do castor oil shakes. Two big spoonfuls of frozen orange juice, a scoop of vanilla ice cream, and 2-4 ounces of castor oil (depending on the urgency necessary)... blended in the blender and glugged like nobody's business before it separates again.

But then, before labor with Aimee, I mixed it with orange juice... shaken. By the time the shaking stopped, it was already totally un-mixed and vile. There are not many more vile tastes in the world than castor oil. Hard to believe our grandparents/great-grandparents had to take a spoonful of it every day. blech

I shoved the concoction down my throat as fast as I could and tried, for at least 30 minutes, not to vomit. I never did get diarrhea.

No contractions 4 hours later meant that I had to do the mixed drink again.

And some people do add a shot of vodka/tequila/rum in their orange juice/ice cream mixture. I didn't.

I drank it again and really thought I was going to be ill that time, but I kept it down. I probably should have puked. It might have helped. I still didn't get diarrhea that is the hallmark of castor oil. You'd think 8 ounces would have done something, right?

At 36 hours, my hebamme couldn't keep me as a client anymore. I was devastated. That meant I had to have a baby in the hospital - again.

I called Mary Carol the next day and she said to come in at 72 hours ROM and we will consider an induction. I cried and began writing a birth plan.

Of course, I was taking my temperature every 4-6 hours, nothing in the vagina, wiping front to back (which is really hard for a fat chick), and taking Vitamin C... and staying home. It was hard not going out, to the park, to the PX, seeing my LLL friends, but I did what I knew I should do.

My membranes had ruptured on Sunday morning. Wednesday morning, I went to the hospital where one of the other CNMs met me and hooked me up to the monitors. The baby sounded great. I had assembled my cadre of spouse, girlfriend Pam who lived 2 hours away in Bad Kruznach, and another LLL leader friend (who abandoned me once I came out as a lesbian) and we all were stuffed into the tiny triage room where I laughed and laughed and laughed, making the monitor jump around noisily, sending a nurse in every few minutes to re-position the belts looking for my bouncing baby... jiggling baby, is more like it. I sobered as long as I could while they re-positioned things and then, as soon as she would walk out, we broke into hysterics once again. I can't remember what was so funny, but can guess it had something to do with a baby coming soon and my not even being in labor yet.

After they had enough of a strip, the CNM came in to do a vaginal exam. I bristled. As she did the exam, she had the strip of Ph paper in her hand to check for amniotic fluid. She also had a long q-tip to collect some fluid to put under the microscope to check for ferning.

The Ph paper came up negative.

Huh?

Puzzled, she inserted a sterile speculum and rubbed the swab into my very soft, but closed cervix. After waiting for it to dry on the slide, she wandered over to the microscope. Peering in, squinting, and then lifting her head, she looked back down and then at me. "It's negative," she said.

What?! Negative?

No amniotic fluid could be found.

Am I sure it had broken? Yes.
Did I keep leaking? Yes.
When did the leaking stop? I dunno. I thought I was still leaking.

Mary Carol called and talked to the CNM on and said to let me go home and wait for labor to start. I was ecstatic!!!!

The CNM tucked a doppler into my hands as she shooed me out the door to go home and wait until labor began on its own. I was stunned.

I went home and started on yet another birth plan.

I composed a birth plan for L&D, another for the Newborn Nursery, one for Recovery, and yet another for the Postpartum floor. With Mary Carol's help, I arranged meetings with the head nurses of each department and scheduled an appointment with the neonatologist as well. I was to meet them all on Friday.

No labor still by Friday, so I headed into the hospital for a full day of discussions with head nurses and a doc. Fine, fine, fine, they all said, when I spoke about minimal interventions, freedom of movement, wearing my own clothes... all those things that were incredibly daring to ask for at the time.

The meeting with the neonatologist was some different. Armed with my list, we spoke, for over 2 hours, going point by point, about what I wanted or didn't want. Discussing such things as dextrostix, bili sticks, baths, eye ointment, Vitamin K, early discharge (I was shooting for 6 hours postpartum... 48 hours was early discharge during that time), and breastfeeding continuously (unheard of at that time). The doc was amazingly cool about everything. He signed off on every single want of mine, even lowering the early discharge from 6 hours to "4-6 hours!" The only sticking point was the Vitamin K shot. After discussion, I acquiesced and accepted the shot, but we negotiated getting it right before I walked out of the hospital. No problem! He'd allowed for no bath, early discharge, no erythromycin, getting the baby in the recovery room and everything. I could live with the Vit K shot.

The head nurse of the Newborn Nursery typed up the agreements, the doc signed, I signed, and the nurse signed. I still have that original to this day. I was very proud of what I negotiated.

Labor began quietly on Sunday morning, while it was still dark. 7 days after my membranes ruptured. I slipped out of bed and went to labor/lie down/rock in one of the 13 bedrooms the
"bowling alley" housed. (The bowling alley is the top floor of military housing... the 4th floor... all bedrooms, lined up down a hallway. Freezing the further down the hall one went.)

I remember the dark of the room. My husband checked on me periodically, but pretty much tended to 3.5 year old Tristan and 23 month old Meghann so I could labor. I felt good. Ready. I would lie down sometimes, but found myself sitting and rocking again during a contraction.

My labor with Meggie had been 39 hours long starting when contractions had gotten down to 5 minutes apart. 2 hours of pushing.

This time, there was no time. I just rocked, alone, in the dark.

At 12:15pm, spouse came in to say that Meggie really needed a nap and could I please nurse her. I dreaded it. Her nursing was the reason I had slipped into one of the other rooms earlier in the day. She made contractions come on hard. After a week of trying so hard to get labor going, once it got going, it got going fast and hard with suckling.

I took Meghann reluctantly into our bed (we all slept together) and laid down to nurse her inbetween contractions. She latched on and I had a GIANT contraction that ruptured my membranes... again! Here we go, I thought.

I stepped out of the room, leaning on the doorjam and told my spouse that it was time to go. He said he had to take the kids to the sitter, so gathered them together and whisked them off to our friend's apartment in the housing complex a mile away. While he was gone, I called my friend Pam in Bad Kruznach and told her I hoped she'd make it. I called Kathy and gave her directions again to the hospital (she'd lost them). During the direction-giving, she kept saying, "Are you pushing?" "You aren't going to have that baby alone, are you?" and I just plowed on with directions.

When I hung up, my husband walked in, all casual-like and I told him it was time to go. He looked at me... I was leaning over the military-issued brown squared chair, contracting hard, sweating like a banshee in my blue dress... he looked at me and said I had better get control or they were going to give me drugs. He barely knew I had been in labor, but I really had only been in labor at all for 7.5 hours. He really thought I had a long, long way to go.

He went into the kitchen and started cleaning the rice and beans he'd made for lunch. It was about 12:50pm. I told him I really thought it was time to go and when he blew me off again, I left without him. I screamed at him as I slammed the door and headed down the stairs. I don't know where I thought I was going and I probably should have stayed put, but I was going to go, with or without him.

He followed once he realized I was serious.

Going down the stairs, I had 2 contractions every half flight. I was crankin'!

Outside was heaven! I was sweating so profusely, I couldn't get cold enough. It was April 20 and 40 degrees outside.

Spouse opened the car door for me. We had a two-door red Toyota Tercel, 1982. I got in, sitting, and he went to the other side. A contraction hit and I jumped out of the car. Spouse jumped out to come and stand with me. DON'T TOUCH ME!! Contraction ended, I got back in, this time on my knees facing frontwards. Spouse got back in the driver's seat. A contraction came and I jumped back out again. Spouse jumped out, stood next to me and I hollered for him to lower my seat's back as the contraction began to fade. Once the contraction was gone (sort of), I got in on hands and knees, the back of the seat at a 45 degree angle, me hanging over it. Spouse jumped fast into the car, closed the door and headed off.

Now, he caught on that I was pushing. He began chiding me to stop pushing. Blow! Blow! Blow! Blowing wasn't doing anything but allowing me to push with lots of hot air.

Driving the 7 minutes or so to the hospital, it seemed like forever. Contractions sped through my body a lot faster than the Toyota went through the Frankfurt streets. Thankfully, it was a Sunday, so minimal traffic, but it wasn't as fast as I wanted/needed it to be. I remember looking up and thinking, "We are only this far?" Several times.

Frankfurt in 1986 was a volatile time. Bombs exploded around the city off and on. Right before Aimee was born, an entire section of where our PX compound was had been blown to bits, the used car lot, part of the Burger King... it sucked, but it was a part of our day-to-day existence. Much like it is now, actually.

Because of the bombings and high alert status, the extended inspections were going on. Normal inspections included long handled mirrors being run under cars and trucks, opening the trunks and hoods of cars, and asking driver and passengers to please step out for a visual inspection. The extended inspection included running dogs through to sniff for bombs.

Our hospital (which doesn't exist anymore) was less than 3 miles from the PX area, so had barriers entering and at least two MPs on at any given time, and they were running the dogs through cars. Even on April 20.

I was full-on pushing as we pulled to the guard shack in front of the Army hospital and as the guard asked for our IDs, I gave the most gigantic push possible so they got it that a baby was coming out my vagina. The guard wavered, but finally said, "Go! go!" and waved spouse through.

Pulling around the left of the hospital, he stopped at the foot of Labor and Delivery. Jumping out of the car, he ran and opened my door so I could get out. I yelled that I couldn't move, to go get someone fast. As he started off, I told him to check and see if the baby was there. He lifted my aqua dress and said, "nope" and I said, "Go!"

Working at the hospital as a doula (before the word doula existed in our lingo), I knew their pet peeves. One was the doorbell. The nurses and doctors hated when someone would come through the double doors without being invited in after announcing their presence with the doorbell.

As spouse was running up the long ramp to L&D, I screamed, "Ring the doorbell!"

And then I was alone. With my baby. I was kind of upright, kind of leaning over the seat and I felt another contraction coming on. I was the most present I had ever been with any of my labors in that one moment... in those 60 seconds where I was alone. Earlier in the day, I was pretty present, but I was also worried about noises with the other kids around and stuff. This moment, there was no worry. Just peace. Me and the baby. Just me and the baby.

I felt her drop into my vagina. From uterus into vagina. It was incredible. 19 years later, I can still feel that feeling. As if it were a minute ago. I know I smiled.

And then chaos ensued.

A nurse came running down with my spouse, she pushing a wheelchair. "Get in! Can you get in?" she implored. I calmly said, "the baby's here" and the nurse lifted my dress and saw her head. "Shit!" she hollered and told someone to go get the precip pack. I learned later that the nurse was a CNM who hadn't gotten her paperwork to deliver yet at this hospital. So, when they ran in for the precip pack, they also called for the doctor.

I learned 2 days later that the women in the day room were watching the scene unfold. They could see out the window at the car, hear the nurses hollering for a doctor, and all plastered their faces against the glass to watch me birth my baby. Dr. Mark Repka clomped clomped clomped down the hall (wearing Birkenstock clogs as all docs back then did) and dashed through L&D, down the ramp and to our car. I knew Mark from working as a doula. He was one of the kindest docs in the mix and was glad, later, that I had him. At the time, however, I didn't care a whit.

Mark hovered outside the car, me still on my knees in the car, and Aimee barrelling out. He implored me to get down onto my side and I balked. He said, "she can't come out this way!" and that was enough to get me to flop over onto my right side, face into the back of the driver's seat. I suppose in skinny women, babies can come out with moms on their knees in a bucket seat, but for a nearly 300 pound woman, the doc was actually right. Thighs and ass, all in the way.

The emergency brake jammed into my right side and I was suffocating from not being able to breathe, my face crammed into the plastic car seat. Over and over I said I couldn't breathe, but all the activity was down at my bottom end, so no one heard me. In a momentary lull, I said it again and Mark sent spouse around the car to lower the car's front seat back. As he did, I inhaled deeply, felt Aimee coming, and spouse grabbed the camera sitting in the back seat.

Mark said to the CNM, "scissors" and I yelled, "No episiotomy! No episiotomy!" and Mark said, "Mrs. (last name), you are in the car, we are not going to do an episiotomy." Aimee oozed out of my vagina easily. Her sister had been 10 pounds 6 ounces at 20 inches long... a nasty shoulder dystocia. This baby, a girl, weighed 8 pounds 13.5 ounces and was 21 inches long. Her older sister had paved the way.

Mark said, "scissors" again and I yelled, "No episiotomy! No episiotomy!" and he laughed, along with the others and said, "Mrs. (last name), the baby is born, I am not cutting an episiotomy. I'm cutting the cord."

Because it was cold, cold! they cut the cord zippity doo dah and whisked Aimee into the hospital.

The entourage followed.

I was left alone with one nurse's aid and a wheelchair.

I need to break for a sec... lemme put this up and then continue later. My fingers are tired!

A Story

A woman 20 weeks pregnant feels she is going into labor. She'd already lost twins at 23 weeks and another baby at 20 weeks, so she has a pretty good idea of what she is talking about.

In the hospital, they explain she really needs to consider cerclage... where the cervix is sewn shut until the end of pregnancy. She agrees. She is 2cm dilated already.

During the stitching, her membranes are accidently ruptured.

She is now hospitalized, ass end up (Trendelenberg position) with monitors on as she waits another 20 weeks for her baby's birth. She doesn't move except slightly side to side. No bathroom privileges. No trips to Babies R Us for receiving blankets. No La Leche League meetings or childbirth classes. Just lying, ass end up in a hospital bed, waiting.

The hospital doesn't have an exquisite NICU, so through consultation, it was decided to wait until the woman was 24 weeks along and send her to the Big University Hospital (BUH) where they could take better care of the baby should he be born early.

During the weeks, a guess is made that the membranes have re-sealed, however her amniotic fluid volume remains terribly low... between 2 and 4. Normal would be 18.

The extremely difficult 4 weeks go by and the woman, via ambulance, ass end up, is shipped to the BUH.

At the BUH, the doctor admits her and says she doesn't need to remain ass end up anymore. That there is no research showing that Trendelenburg does anything for women trying to keep a baby inside... that there is pressure anyway, so she might as well get up and do something. She refuses. She asks to see another doc who says the same as the first. She asks for another. Same answer. She goes through this 6 times, including with perinatologists, who tell her it is fine to get up.

She doesn't believe so, but she guesses they must know what they are talking about.

The nurse gives her a sleeping pill for her agitation and sends the woman to the bathroom to pee before bed. It is the woman's first upright in over 4 weeks.

She climbs back into the bed and the nurse attaches the monitors back on and wishes the mom a good night.

About 30 minutes later, the nurse wanders in and says the baby must have moved because they haven't heard the baby in about 20 minutes.

She can't find the baby, so they bring in an ultrasound machine. The baby's heart has stopped.

A vaginal exam shows an occult cord prolapse through the 2.5 cm open cervix.

This happened here, to one of my midwife's clients, last week.

The mom that lost her baby is a lawyer.

Thursday, March 03, 2005

My First Cesarean

Frankfurt, Germany - mid-late 1986

A woman found me via LLL (I was a leader back then) and asked me to be her labor assistant (no such word as "doula" back then). She was, after research, going to deliver in a German birth center. She did not, under any circumstances, want to have her baby in the military hospital (Frankfurt Army Regional Medical Center [FARMC] - it no longer exists). I don't remember if we talked about the what-if's... I know that I do now - but I remember being extremely excited about doing a birth out of a hospital in a foreign country.

We toured the birth center and met the midwives, who spoke minimal English. I loved the space. The rooms were so pretty - a garden yard could be accessed through the back doors of each room - and we moved through the space "seeing" my client in labor and knowing how great it was all going to be.

Labor time came and I met them at the birth center... mom was 6 cm dilated. (Isn't it amazing I can remember all these details? I had journals, but in a huff, my former husband threw them all out. My remembering birth details is in lieu of remembering songs - songs are lost in my head; birth details are retained forever!) Labor progressed really beautifully and mom spent a lot of time in the big bath they had in the room. It was cold outside, rainy, as usual, but warm inside and the steam from the warm bath made everything damp and soft.

Minimal vaginal exams were done, but mom asked for another several hours after one exam showed she was 8cm. When the midwife said she was still 8cm, the mom began to cry. As the midwife remained inside the mom, looking up at the ceiling (as midwives tend to do to be able to "see" with their fingers), I could tell she felt something besides the cervix and the baby's head. When she removed her hand, she began telling my couple, in her broken English, that she felt the baby's face presenting, which could hinder the cervical dilation. Through the years, I have studied face presentations and all-to-often, face presentations don't allow for enough pressure to dilate the cervix effectively. If given lots of time, it can happen, of course, but not everyone wants to wait that long.

And, the baby's head has to be in a posterior position to delivery vaginally, complicating the pain aspect of the woman's longer labor. If the baby is anterior, the neck cannot move that way through the pelvis without extensive damage. (For midwives and midwifery students, the mentum/chin needs to be anterior, which makes the head posterior - I've played with a lot of dolls and pelvises to be able to visualize this one. Researching, it is harder to find where the head needs to be since the usual discussion is regarding the mentum, not the cephalic presentation itself.)

The midwife said she wanted a second opinion from the doctor and when he came downstairs and examined mom, he said he could only feel an eyebrow, not a nose or eyes as the midwife said she could. He told mom she was fine and could keep going, even though she had been at 8cm for at least 6 hours with fabulously strong contractions.

When he left the room, the midwife sat there with a funny look on her face. My client was laboring, but I said to the midwife, "what do you think?" and she said, "I feel a complete face." My wonderfully strong laboring mom asked me who I believed. I said, without hesitation, "the midwife" because I knew that she had felt FAR more normal presentations than the doc and that if something was different, she would totally know. Mom asked for another exam before we began discussing alternatives and the midwife said she could clearly make out the mouth, nose, and one eye. Discussion began.

We talked about options. Augmentation with pitocin and cesarean were the two options we didn't have at our disposal at the center. Mom cried a lot during the talk, but she was an active part of the decision making.

As much as she did not want to go to the military hospital, she REALLY did not want to go to a krankenhaus, a German hospital. Not knowing if someone was going to speak English, knowing that a mediolateral episiotomy was SOP, that general anesthesia was SOP for cesareans... those options seemed worse than dealing with the military shit she had tried so hard to avoid.

I had been working at FARMC as a labor assistant for about 9 months by then. The nurses and docs all let me in - some tolerating me, others welcoming me - and I knew them all and knew most of their styles and personalities. During my time at FARMC, L&D was in two different parts of the hospital due to reconstruction. I had my baby when the hospital was on the lower portion of the hospital, right at the ramp to the parking lot. When Sarah had her baby, Aimee (my car baby) was 3 months old. The maternal death I witnessed was when L&D was up on another floor. In remembering, I thought that happened in 1986, but it might have happened in early 1987, but most likely late 1986. I wish there was someone around to ask so I could piece the time together. I know this is pretty irrelevant to readers, but for me, it helps me put the time frame together. When remembering being a doula back then, the births are distinctly divided between floors. It's good for me to write that down.

When it became apparent that a transfer would be needed, I called FARMC to find out who was on and to give them report. Blessedly, blessedly, the doc that was on was my favorite... very loving and kind... just the kindest doc at the hospital (the doc that caught Aimee and did my abdominal surgery was my second fave - fave for surgery, but not for birth). The head nurse was my favorite nurse Sally who was pregnant with twins and, years later, she became a CNM in the deep south (USA). When I was able to reassure my client of the kindness that would meet her, it made the transition so much easier. On the phone, Sally said it would depend on what was going on, but that an automatic cesarean wasn't what they would do. That also helped.

We drove our own cars to the hospital and the move into the labor room was typical with the changing of the clothes, the bracelet, the IV, etc. All stuff mom didn't want, but knew she would be getting simply by stepping inside their doors. Once the doc came in and examined her - she was still 8cm and it had been at least another 4 hours since the first 8cm observation - he said the baby was posterior, the ideal position for a face presentation birth. He said he had done face births and didn't have a problem at all with her continuing. Mom was relieved! He offered pain meds; mom declined. He offered pitocin; mom declined.

She labored for 4 hours and had another VE. 8cm. The doc said that he really thought she would need some pit to put enough pressure down on that cervix to get it open enough. Mom declined, but also said she couldn't do any more. She'd been 8cm, with 8cm-type contractions, for about 14 hours.

Discussion of a cesarean began. No one was harried. No one was mean. Everything was explained quietly and respectfully and mom, even as she cried, she was able to verbalize her desires for remaining close to her baby, staying awake, nursing soon, etc. The hospital said they would do their absolute best to adhere to her wishes. I believed them.

I hadn't ever been to a cesarean birth before. While I was disappointed for my mama, and damn tired from standing for so long (I weighed about 280 at the time), and am sure my boobs were going to explode from not nursing for so long, I was also excited to get into an OR. Oh, yeah, they were letting me in!

Sally asked me if I knew how to behave in an OR... would I get sick? I said I would not get sick, yes, I knew not to touch anything, to stay out of the way, etc. In reality, I knew nothing. laughing

Dad was in the room with mom as she answered a thousand pre-op questions. She'd asked me to stay to help with contractions, so I was privy to some information I hadn't known about. When mom was asked about how many times she had been pregnant, she said 3. Live children? none. Spontaneous Abortions? None. Therapeudic Abortions? Two. I didn't think anything of it, because that's how I am.

Mom was taken back to the OR to get the epidural before dad and I were brought in.

I was given scrubs and had to ask for bigger ones three times. I ended up in XXL men's gowns (one forward/one backward), only undies underneath (I didn't know to keep my clothes on back then). I put on the shoe covers and the head covering thingie. And I waited with my camera.

I was in the labor room waiting with dad and he was really quiet. I asked, in my labor assisting way, if he was okay... that this was quite different than they had planned for. And he looked up and said, "she never told me about the abortions." Oh, my. I gently said that he might wait a few weeks to talk about that, how hard that must of been for her to share in public and in front of you and she was birthing his baby in a few minutes... and I hugged him, letting him know it must have been hard information to hear.

This taught me to let women know, at any time I have a second of a private moment with them, that if they have stuff to share that their family doesn't know about, to ask everyone to leave and only speak with the nurse alone. I also, in interviews, tell them that if they ever want to speak without me in the room, too, just say it! I take no offense whatsoever.

As I was putting my OR suit on, I made sure my hair still looked good. I had a perm at the time and I floofed my air as a halo around the edges of the elastic paper cap. I looked good.

We were escorted to the OR where mom was already splayed out cesarean-style and Sally walked up to me and grabbed my head thingie and shoved my hair under the cap totally. I'm sure I gave a little whine and she stood back and glared at me: this is surgery, not a beauty pageant. I clamped my whine shut. I knew I would have bad hat head, but pushed it out of my mind.

I'd never had a mask on before. I remember that I felt lightheaded the first dozen or so times I wore one until someone explained to me to JUST BREATHE NORMALLY! What a concept, eh? I don't quite know how I was breathing, but it wasn't normally. Plus, the way I was breathing, my glasses kept getting fogged up. Years later, someone showed me the trick of pinching off the nose clip so the air doesn't zoom up to the glasses. For this birth, however, I was breathing funny, felt lightheaded, had foggy glasses, and worrying about my hat head.

Dad was plopped down on the head stool, but I was allowed to wander around the OR to take pics. (Something that would never be allowed nowadays.) As her belly was being opened, I smelled that burning flesh odor I'd never smelled before - and immediately thought of the smell of the Holocaust, feeling all light-headed again. I faked it, though, and forced myself to chill and Be in the room with my client.

I saw the uterus and it was so beautiful! I leaned forward to snap a picture and Sally, my OR shadow, snipped the cord of my camera right off the camera! I pulled back and looked at her confused-like and she looked at me (the only thing on her face that was visible were her eyes) and said, behind her mask that I was about to lean over onto the instrument table and my camera strap would have contaminated everything on there. I blushed.

Stepping over the now-dead-on-the-floor camera strap, I carefully took pictures as the cesarean unfolded. I became much more aware of my space and place in the small OR.

My client, awake and excited, yet crying at times, listened as her baby was born in a loving and respectful manner. I am eternally grateful that my first cesarean experience was so positive and gentle.

Her son, weighing 9 pounds 12 ounces, came out and for two weeks after birth, held his head as if he was watching angels near the ceiling; the back of his head touched his spine.

During mom's physical recovery, she thought lots. She wrote me the most beautiful card, many words shared, about how, in a place she'd dreaded spending time in, she'd found that she could trust even those she'd never trusted before. She said the lesson of putting your life, or the life of your child, into the hands of strangers and trusting them to care for you was the hardest thing she'd ever done. She said she learned a lot about trust and belief.

I learned, too, that women can have decent experiences in the hospital. Of course, over the years I have seen the worst of the worst and the best of the best, but, when medical care is needed, it CAN be decent. Should be, yes, that's a given. I have worked hard to know how to make it decent over these years. Most times I succeed. Sometimes, it is absolutely out of my control.

4 years later, mom was in the US in the northeast and had found a birth center to deliver in. She was strong in her desire for a VBAC and I knew she could do it. We talked during her labor, sometimes 2 hours at a time, and when she hung up the last time in her labor, she was pushing her baby out of her body. Her VBAC was a triumph for her! As VBAC is for all of us, even those of us who've never had a cesarean at all.