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
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.