Friday, May 19, 2006

Hospital Birth

went to bed at 10pm and was awakened at 11:30pm to dad telling me mom was working hard with contractions and had been since 9:30pm or so. I told him to come on down the mountain – about 90 minutes from my house.

My family went into overdrive, doing last minute cleaning, readying, and making sure the hot tub was at a decent temp (we initially had it set for 100, lowered it later when the baby let us know 100 was a tad too high). I tried to sleep, but that wasn’t going to happen.

At 1:00am, mom and dad got there, mom in pretty good spirits, but working. I didn’t do an exam. I called the other midwives/apprentices at 1:30am to give them a head’s up, but to tell them things weren’t really cooking yet, so they all asked if they could sleep longer. I said, “Sure, I’ll call later,” so I got off the phone and tended to my mama.

Wandering through the house, we laughed and talked and spent time with each other… everyone in the house was awake except my daughter who, miraculously, slept through it all.

Our puppy was the hit of the labor… squealing, hopping around, delighting all of us at his antics. Luckily, this mom loves dogs, so neither dog had to be corralled until later in labor.

This mom had the Going Into Labor Chicken Parmesan at Olive Garden (for those looking for the natural route to provoking labor, this works loads) earlier in the evening, but barfed it on the way to my house. She wouldn’t eat anything and it annoyed the crap out of me. I finally, FINALLY got her to sip some Propel, but she only took two bites out of the whole grain bagel with peanut butter. Frustrating. She did sip some water, but not nearly as much as I thought she should have been taking in.

Things seemed to pick up nicely, so I called the others to come over about 5:30am and they came willingly and cheerfully.

Mom loved spending time in the spa. She couldn’t wait to get in and hated getting out a couple of hours later when the baby’s heart rate was up to 190 (eek!). We turned the spa down to 98 and when she got in later, the baby liked that much better.

I’d never seen mom naked until the moment she disrobed to climb into the spa. It was then I saw her pendulous belly and thought, “hmmm.” Primips don’t usually have a pendulous abdomen.

Contractions were off and on strong, frequent, slowing, sharp, dull, and then absent. Malposition/malpresentation was definitely a consideration.

Mom went to lie down for awhile and I got about 2 hours of sleep, waking each hour to listen to the baby’s heart tones. They were wonderful.

When mom awoke, she still didn’t want to eat, but after some walking, wanted to get back in the hot tub. She got in and after a couple of hours, as dawn was turning into broad daylight, she began pushing. I’d done one vaginal exam before the others came and she was 5-6 cm. I did another exam at 9:30am because pushing wasn’t productive (mom couldn’t feel anything at all in her vagina and the contractions were odd… 30 seconds long, 6 minutes between… we waited to see if she just needed to rest, but I knew she needed food and some help with positioning).

She loved being on her hands and knees in the hot tub, loved semi-squatting in there, too. In the house, she was on hands and knees. Knowing what I know now, those were the absolute worst positions for her. I should have bound her belly a dozen hours before we finally did it.

The exam at 9:30am, after a couple of hours of pushing, showed she was 7-8 cm. Pushing needed to cease. Her cervix was really soft and buttery, stretchy, too, but not so stretchy as to allow the head to slide through. Just the suggestion of not pushing was enough to slow her down. She’d been pushing in her head as it was… I told her several times I was worried about her teeth breaking off because she was pushing in her mouth instead of her bottom. I’m sure the real urge to push not even being there brought the I’ve-Got-To-Push action right into her jaws.

Somewhere around 11am, mom got out of the tub and went to the bed to rest. I was dozing on the couch on my partner’s lap and had the most vivid thoughts about this birth.

I saw myself catching the baby and he came out grey and completely floppy. The cord was flaccid. The baby didn’t breathe. I watched from my dream place and thought, “oh, no… we aren’t supposed to be here.” I knew if we weren’t at the house, then that scenario couldn’t play itself out because I wouldn’t be catching.

While I dozed, the two apprentices were doula-ing the mom and came out and said she was so discouraged and tired, she didn’t know what to do. I went into the room and within moments could see she was waning fast. Whenever she sat up, her face drained of blood and I was so worried she would faint. She still refused to eat, didn’t want an IV, but when I offered her the options and included the hospital, asking if it was time to go, she said that it was time.

This was 1:30pm.The other midwife and her apprentice stayed behind to clean up and my family cleaned everything else. By the time I got home, the hot tub had been emptied, sterilized and re-filled with a new filter in place. Damn she’s good!

We got to the hospital about 2:30pm and went right into the birth center. I parked the car and was going quickly up to the birth center, but a gaggle of interns in black suits were lolli-gagging their way into an elevator and I had to nearly scream, “I’ve got a baby coming out! Move with a purpose, PLEASE!” They got their asses moving after that.

A midwife I know was on duty and I was delighted about that. A wonderful, wonderful nurse was ours – she’d been a childbirth educator 40 years ago and taught the midwife I work with a lot how to doula 20 years ago. She also had a lot of home birth experience in her life. We were so, so fortunate.

An IV was started and antibiotics started. The CNM asked to do an exam and mom said okay. She was 7-8cm.

Still.

Ohhhhh, she was not happy. So, options were discussed… she was asking for help… isn’t there something she can have and still stay in the birth center? Nubaine and Phenargan were administered and mom slept for 2.5 hours. I went to the family room and my apprentice brought me a blanket and pillow and I crashed for 2 hours… hard and fast.

It’s hard to be “up” this long for me. Not always feeling so well, I take pains to stay calm and as healthy as possible, but it’s been a long, long while since I have had to be awake and working so long. Blessedly, those around me, clients included, understand and allow me to rest when I need to. When they need me, my adrenaline zips right to where I need it to so I can take care of my clients. (I certainly have had thoughts of stopping/slowing, wondering if I am giving my clients all they deserve, but I keep being told it is worth the small moments in time I am not present so I can rest. So I keep going.)

When I awoke, mom had been examined again and had a cervical lip. A new CNM was there because the birth center was full and many CNM clients had to be moved down to L&D for a variety of reasons. This new CNM was someone I hadn’t ever met before and I had the feeling she wasn’t too thrilled to see an LM, ER Nurse, doula/apprentice and dad flanking the woman in labor (who is also a doula!).

Within moments, though, she warmed as I offered to help her however I could. Because of all the commotion, I was allowed to take a lot of “control” over the mom’s care. I kept the doppler near me and took heart tones, reporting to the nurse as she charted when she was in the room.

My apprentice is a doula at this hospital, so knew her way around… got us pillows, bean bags, juices, water, ice, blankets, towels, the birth ball… all things to help mom be more comfortable.

Mom was up pushing on the toilet, hands and knees, on her side, in the chair, and standing. Her water broke spontaneously and there was thin meconium. Later, during an exam, there was forebag the CNM removed. More thin mec.

When she was lying in the bed, I looked at her belly and it looked exactly like a posterior baby belly… a slope up above the umbilicus, a dip at the belly button, and a slope again below the umbilicus. I went and talked to the RN, telling her how concerned I was about the pendulous abdomen and my belief that it was keeping labor from being as productive as it could be. She agreed and went and found me a binder.

Mom’s contractions had once again petered out… every 7-10 minutes, lasting 20-30 seconds. One nurse said it wasn’t uncommon to have them do that right before pushing and I explained that she’d been complete for at least a few hours. Oh, different story.

We put the binder on and within moments contractions picked up… every 2-3 minutes, lasting 60 seconds. A huge difference!

After an hour, mom just couldn’t do any more. The contractions had stopped again and she was so discouraged. Asking what her options were, I laid them out.

1. She could go down to L&D and have an epidural with pitocin

2. She could go down to L&D and have pitocin

3. She could go down to L&D and have pitocin with possible vacuum extraction

There simply wasn’t much else to do in the birth center. Luckily, we’d still have CNM care down there, but she’d have to have continuous monitoring. She accepted that reality with grace.

This mom, after weeks and weeks of whining, was so amazingly stoic and brave during her labor. I was more than impressed and told her so about 80,000 times. She never whined, merely demonstrated her exhaustion and frustration. She winced, but didn’t scream or cry (not that those are a bad thing). She was so different in her labor compared to her life, I was so, so proud of her.

She went down to L&D on a gurney and I went down after dumping my stuff with one of the relatives in the waiting room.

I was in the hall, walking towards the room and I could hear a nurse screaming at my client to PUSH!! PUSH!! and she was counting so loudly, as if my client was stone deaf. I grabbed the new new midwife (another one I didn’t know before that moment) and told her to please tell the nurse to stop shouting at my client. We went in and that bitch nurse was trying to get my client to grab the handle when she didn’t want to… the nurse pulled her hand off the bed rail and pushed it to the handle, all while yelling that she needed to draw PIH labs (her BP was rising… no wonder why!). She then began yelling at her again to PUSH, but didn’t count and I stepped next to her and looked her right in the face and said, “You have GOT to stop yelling at her. She doesn’t need to be yelled at.” The nurse was stunned, spun around and snorted before leaving the room, never to return.

Instead, we got a marvelous, wondrous, beautiful traveling nurse that was so supportive and loving – along with the CNM – that the time in L&D was nothing like it could have been.

I asked for a birth bar so mom could leverage her feet on the bar and we threw a sheet over the bar so she could use it to pull as she pushed and the difference for her was great. As tired as she was, she showed amazing strength pulling and pushing. We’d gotten down to L&D at about 7:30-8:00pm and because she was doing well, the monitors were unstrapped and no pitocin was started at all. She already had the saline lock for the antibiotics every 4 hours and they did put some Lactated Ringers in her for some energy, but they were extremely casual about the typical L&D freak out issues.

Right as I met the last CNM we worked with, she smilingly asked if I wanted to catch. Blinking, I was pretty shocked she would say that, even though the earlier two had asked the same thing. I mean, now we’re down in L&D! I told her I would be delighted to catch, but to let me know what I could do to help her. She said, “have a great birth.”

As mom pushed actively, I sat at the bottom of the bed helping her with focus and not to clench her teeth out of her mouth. She really didn’t have the hang of where to push at all and no amount of telling her was helping. I touched her vulva with cool washcloths (she was getting swollen and had some varicosities developing) and tried to direct the pushing there, but it wasn’t much help at all.

Throughout the labor, I made mom laugh about different things and here at the foot of her bed, I was being a little silly and making everyone laugh. After hours and hours of maybe 5 words an hour, this mom, in complete coherence, looked me in the eye and said, “I need help. I don’t think I can do anymore. Please help me.”

I stopped the humorous words and looked her in the eyes and told her she could do it, that she could take all the energy she wanted from all of us in the room… that we loved her so much and we all had plenty for her to take, but that she was so close (we could see about a quarter of the head peeking through).

With the next contraction, I encouraged her to reach down and touch the baby’s head so she could find some inspiration.

Mom reached down with her left hand and something miraculous happened! Whereas she had been pushing with all her guts (no one yelling at her at all, or even directing her pushing, but the wonderful nurse in her ear, talking her through it all) and making very, very little progress, when her hand touched her baby’s head, she barely had to sigh to have the head advance. I loved it! She would be holding the head and her baby slid out very, very slowly. If she moved her hand, she tried pushing and had zero progress. My job was to remind her to touch her child and eventually helped to support her perineum, but no pulling, tugging, or anything invasive.

Because the head was being born so, so slowly, I watched the CNM thinking like I was and she stepped up onto the bed over the mom in case of a shoulder dystocia. I looked up at her and she said, “just in case.” I nodded knowing exactly what she meant.

As the head was born, there was very little restitution, but as he started to turn slightly, I utilized the skill I learned ages ago of helping to birth the baby before the shoulders get caught behind the pubic bone. Pressing down on the shoulder to get the anterior shoulder born and then pressure up to birth the posterior shoulder, I felt for a cord and didn’t feel one, but as his anterior shoulder was being born, there was a cord… absolutely limp and flaccid. I looped it over his head and put him up onto mom’s belly with her hands helping. (I’ve since apologized to mama for pressing her child’s body like that, but it was the right thing to do at the moment… I also told her I’d pay for a cranial sacral/chiro appointment for him.)

He was born at 11:32pm. That comes out to about 6 hours of pushing if we were medically counting.

The baby boy was on mama’s belly and we looked and there was a HUGE blob of meconium on the bed, his body covered in mec. The cord so limp, the baby so limp, too. Stimulation did nothing and the nurse said, “Cut” and the CNM was right there, cutting the cord. The nurse and CNM took the baby to the warmer and told me to call NICU. I did and talked to mom, watching her bleeding. I told her she cannot bleed. I told the nurse and midwife I was watching the placenta and bleeding while they began working on the baby.

His heart rate was 100, but there was no respiratory effort, color, grimace, or tone. By one minute, there was a tiny bit of tone and he was gasping, so he got a 3 for his one minute Apgar.

NICU didn’t get there fast enough, so I called again and asked for NICU Stat and they said they were on their way.

I cleared the inlaws out of the room to make space for the multitude about to converge on the baby, asking my apprentice to leave, too, but she was trapped behind the delivery table (and I was glad so she could watch all that was happening).

Dad was next to the baby, touching him… no one ever asked him to move, leave, nothing… they suctioned the baby and got gobs and gobs of thick mec out of him. He was gasping and had serious tachypnea (respirations were 100-120), retractions, flaring, and grunting. The neonatologist stood with her hands across her chest as she directed, calmly and kindly, the actions they needed to do to this boy. At one point, dad turned to me and said, “he’s doing great! he’s breathing!” and I turned to mom and explained that gasping wasn’t breathing. She nodded her understanding.

They brought the boy to mom for a quick kiss and he was whisked off to the NICU where, it was learned later, that he had meconium aspiration. He was, of course, tested for a variety of illnesses, including GBS, but those all turned out negative.

The baby, at 3 days old, came out of NICU and nursed for the first time today (while still in the NICU); nursing is going well, thank goodness!

Mom had no tears, the placenta was born and was incredibly stained by the meconium. The amnion, chorion, and cord were all deep greenish-yellow. The baby had been sitting in the poop for at least 6-8 hours prior to birth. It was then apparent that his aspiration occurred before birth, not during or after the birth. When I knew I was going to catch, I asked the midwife about the meconium and she said since it was thin, she was fine with wiping, so that’s all I did was wipe his face gently. There was very little mec on his face, but his body was muddied with it.

He had a caput that was about 2 inches across and 2 inches tall… a cork keeping the meconium from oozing out to let us know there was going to be an issue.

The baby’s heart rate throughout labor in the hospital was 140s to 150s… perfectly fine. The heart rate less than a minute before the birth was 140. At birth, this dead-looking baby was born… the exact image I’d had 12 hours earlier. I never, never would have expected to catch in the hospital and have that premonition play out as it did, but there it was. Scary as hell.

In working through this with my apprentice, I explained how hard it is to share the reality of why birth workers sit in anticipation of just such circumstances. We sound like doomsday creators, naysayers, scaremongers… when we talk about how really, really the heart rate can be fantastic less than a minute before birth and how it can be zero at the birth and the baby need amazing amounts of help to get started. She, deeply steeped in the UC community, said the UC women would never believe what she saw. I suspect they would think she is being brainwashed, not that she is objective observer. How can the information get out there without making disbelievers close their minds even more? I’m just not sure.

We don’t sit in panic expecting something bad to happen, but readiness is vital. We really do never know what will come out of the experience we are in the middle of.

One more thing. Not sure why, but this mom’s vagina was interesting… different from most. The entroitus was far, far back from where it is with most women. She had virtually no perineum, no inner labia, very thin outer labia that was nearly flush with her thigh in some areas. When I did the first exam, I was trying to get inside her in the wrong place and I’m sure it hurt. I apologized profusely and asked her to show me where. I felt like a dork until the CNM did the same thing. I began telling whomever was going to do an exam about her anatomy and that made a huge difference. The midwives did tell me that her vulva/vagina were different from what we usually see. Again, not sure why, but very interesting.

Whew. I am tired.

Thank goodness the baby is alive and well. Mom is extremely happy.

Home Birth

Dad called at 8pm and asked if I wanted to talk to mom, she’d been contracting for a couple of hours. I talked to her and she said she thought things were starting. I called the other midwife and my apprentice and went to bed.

This mom has worked hard for this baby.

She had had three girls at home, beautiful births. Then her husband had an affair when she got pregnant again and she terminated the pregnancy. They got back together and she got pregnant again and miscarried. She felt the termination was being punished (still does). She got pregnant again and at 39 weeks, her water broke over a velamentous insertion and the baby died from a hemorrhage before she could get to the hospital. This was a boy.

Of course, it was torturous for the family, the girls being old enough to know and remember everything. The feelings of punishment were amplified a thousand-fold and we worked on that throughout the pregnancy.

She was so in denial of this pregnancy, so out-of-touch with the baby, she hadn’t felt the baby move at 20 weeks. She came to me and lying on the exam table, I watched her belly roll with a child inside and she blankly said she couldn’t feel it at all. I took her hands and placed them on her child and she began crying as she realized there was, indeed, a baby in there.

The pregnancy was emotional. Mom, an L&D/Postpartum Nurse, struggled with the shit that happens in hospitals versus what she wanted in another homebirth. Over and over she cried to me about the amount of cesareans her hospital did, the way the women were treated like meat, the episiotomies every vaginal birth had, how scared she was that she couldn’t do it anymore because she saw all that suffering. We talked about pain in bed, the pain of no one loving them, the pain of not being respected… and talked about how she wouldn’t have that in her birth, that she was ensuring that wouldn’t happen.

The girls, all pre-teen were very involved in the pregnancy, guessing what the gender was, picking out clothes, talking and reading to the baby… it was so lovely. I did a photo shoot of the family once and they were so filled with joy, it was obvious where the glue for the marriage lay.

At 3am, dad called again and said it was time to come. Since we had a two hour trip, I knew there was no time to waste. Her last live birth was 4 hours long. I suspected this would be longer because of some emotional dystocia, but still didn’t dawdle. I called the other midwife and my apprentice, got dressed, put make-up on fast, and headed out the door.

I stopped at 7-11 for a Diet Dr. Pepper and a bag of Fritos scoops and drove to pick up my apprentice who happened to live along the way. I got her at 4am.

By 5:30, the sun was rising and we brought our equipment in, checked on mom, listened to the baby, and began setting up.During prenatals, I’d let mom know I would sit and hold the doppler on her belly the entire labor if she wanted me to… if she just needed to hear it, to say so and I would be there for her. She didn’t ask or need us to listen any different than we would normally do.

The other midwife and her apprentice arrived and we sat quietly on the couch. When we got there, things slowed some, so we made ourselves scarce so it could pick up again. Mom was gorgeous in a red silky chemise, laboring beautifully. She asked that we not be offended if she cussed, that she always cusses in labor. I told her we’d never, ever heard a cuss word ever, so that would be a new thing for us. She got the humor after a second and laughed. I told her we would sing cuss words with her if she wanted us to! She liked that.

When things were cooking, she needed her husband right by her side, or rather, in front of her, so she could pull on his arms. She moved from the bed to the toilet to standing to kneeling to hands and knees and back again, swishing her hips during contractions and having a mantra of “shit” and “fuck” that matched the rhythm of the surge.

She wouldn’t let us leave the room and wanted all her girls there, too. They each had been given a job and were doing their jobs beautifully.

The oldest had the camera and was photographing the story. The middle daughter kept thinking she would faint, so her job was to stare in her mama’s eyes so she didn’t have to look elsewhere. The youngest was the washcloth girl and she was to press cool cloths to mom’s face and neck when she needed them.

During one particular contraction, mom was on her hands and knees, face in the pillow and she began crying. I got close to her face and ear and whispered, “what’s going on?” and she just started sobbing. I asked if she knew what she was feeling and she nodded. I said, “Name it… say it out loud” and she wept out, “I’m so sad!” and I touched her hand and told her I could hear that, that she was doing so beautifully with that pain and that her son was right there with her during this labor. Within moments, she stopped crying and labored on. The entire exchange couldn’t have taken two minutes, but it was so powerful, so tender, several of us in the room cried right along with her. I grabbed one of the dry washcloths for my own tears and sent her so much love and light as she had to have been walking through such a deep and dark place for a few moments.

During the pregnancy, she spoke about not bonding with the baby. She was so worried the baby would be “messed up” because she didn’t even know the kid inside. I told her to keep telling the baby s/he would have to “speak” with her eyes, but that you loved him/her for who s/he was and that the child wouldn’t know any different, so please not to struggle doing something she didn’t feel she could do. I asked her when she felt she might let her breath go to believe this baby would get to stay and live with her and she said she wasn’t sure, but maybe when the baby cried… when she could hear his/her voice. I wondered, too, when the connection would find completion.

Mom had always delivered on a birthing chair, but we had one of those low shower stool things set up with a pillow and a Chux on it. She was okay as she began pushing on it, but she didn’t feel she was getting anywhere and seemed frustrated. We’d talked about internal exams and she wasn’t sure if she wanted any or not… hadn’t until I asked if she might want to know where she is, that maybe she wasn’t complete and that’s why the frustrating pushing. I did an exam and it was hard to find the cervix because she was 100% effaced, but she was about 9cm dilated. I could have easily lifted the cervix over the baby’s head, but she hollered at me to stop, that it hurt too much, so I got out of her vagina, never to enter again.

Mom hadn't eaten since dinner, so we tried to get her to eat something, but she didn't want anything, so she had some apple juice. Right away, she got heartburn and we tried to think of how to get rid of that. No Tums in the house, none of us had papaya tablets, and just as the apprentice remembered a remedy on the baking soda box, I thought of peppermint candy and they found some for her to suck on.

When a contraction hit, she was wiggling and I said, "Do you want to spit it out?" and she spit out about 4 chunks of the candy. After the contraction, she looked for it, but we'd already thrown them away. Her heartburn was gone, though, so that was good.

Sitting for awhile, we asked if changing positions might help… perhaps a trip to the toilet. She went and peed and then climbed onto the bed and pushed with the ever-increasing contractions.

She “fucked” a lot and said at one point she thought she was going to die (I actually don’t remember hearing that, but the others hearing it becomes important later), why was it taking so long?

We began seeing the amniotic sac coming through the vaginal entroitus. Opaque and clear fluid – we could see the baby’s hair floating in it! The sac oozed out and then, shortly after, the head began filling the sac and the baby’s head was soon born. S/he didn’t rotate and the other midwife’s apprentice, who was catching, said she thought there was some turtling (I was right there and saw the baby not rotating, but not much turtling), so I helped mom lift her left leg into a lunge and the baby began to let his/her shoulders be born.

Before the lunge, the baby’s head began suffusing and the lips were meowing, so I encouraged the apprentice to remove the sac before the baby breathed in there. She began to pull it off at the eyebrow, but I merely grunted and she remembered to pull from the chin up. (If you pull from the top down, the unlikely possibility of inhaling the membranes as the nose and mouth are freed can occur. I know of one midwife that had this happen, so I have, forevermore, pulled the sac from chin to forehead.)

The baby was born into the apprentice’s hands and we helped mom, in one swift motion, to sit back (she’d been on hands and knees) and embrace her child. She was ecstatic!

The baby was so beautiful and talked to us nicely without hollering. S/He opened his/her eyes and looked around at his/her family and everyone was so happy. Dad was whooping it up, the youngest daughter was crying… later she said from fear and then joy (“mom was yelling so much!”), the other girls were so happy… we were relieved and so honored to be at such a glorious birth. Mom looked up and said, “We’ve bonded.” I thought I would fall over with emotion.

When mom was pregnant, she’d submitted to an ultrasound for students learning how to do obstetric ultrasounds. She told them a number of times to NOT tell her the gender under any circumstances. She told every student personally, told the instructor… yet, when they were doing the ultrasound, they said, “it’s a boy!” about four times. She has to work with these doctors, so she didn’t say anything like, “You assholes!” which she wanted to say. She didn’t tell her family members what the gender was, but told me (which I really, really forgot – on purpose) as I helped her settle from crying hysterically after that ultrasound experience.

She had another ultrasound later, just for kicks, and the ultrasound tech, an experienced woman, said, “Woah! Is your husband black?” (Not kidding.) “That’s some boy you got there!”

The day before she birthed, she had another one and that ultrasound tech told her she couldn’t imagine what the others were seeing, that the baby was most definitely a girl.

So, she went into the birth as she wanted, not knowing the gender of the baby she carried inside.

When she lifted the blanket and the baby’s thigh, she laughed and shouted, “She’s a GIRL!” and the girls who’d wanted a girl were ecstatic… the youngest was a moment disappointed, but quickly was very happy. She did continue calling her a “he,” but I am sure it will take a day or two to get out of that habit.

The apprentice was sitting and watching the bleeding and thought she was bleeding a little too much, so reached up and began massaging the mom’s belly. Alarmed, I sat for a second and she’d stopped. I didn’t see too much blood, but when she reached up again and rubbed, I asked what she was doing and she said “rubbing up a contraction,” I went to her overseeing midwife and said, “I’m REALLY uncomfortable with her rubbing up a uterus that still has a placenta,” and she said, “So am I.” I went to the bed and kindly asked the apprentice to change places with me. She got up without hesitation.

I felt to see if the placenta was detached, but it wasn’t, so I asked mom to give me a push with the next contraction and I did a little controlled cord traction to get the placenta out as quickly as possible. This is not something I would typically do, but I am soooooo glad I know how to do it if I need to. The reasoning was that if the apprentice had dislodged a part of the placenta in her massaging, she really could seriously hemorrhage – an abruption – I wanted to make sure the placenta got out of there whole and soon to avoid any issues that could have possibly arisen.

As it was, she had trailing membranes, but they seemed to come out completely. (Later we saw that a piece of amnion had become dislodged and separated, but pieced together nicely when we completed the puzzle.)

When we explained it to the apprentice, she was mortified that she had done that. She said she knew not to do that! And we told her that nothing seriously happened, thank goodness, and we bet she’d never do it again in her life as a midwife. She said she would not!

I continue explaining it to my apprentice. I suppose the concept is a tad challenging, though, since I have had to explain it in different ways. It was a great lesson for me, too, to STOP someone from doing something I know is wrong instead of saying something first to someone else.

My reasoning (not excuse): This other midwife and I research a lot. She and I have learned great things from each other… putting oxygen on the mom to help release the placenta (my trick)… injecting saline into an umbilical artery to do the same (her trick)… and I had a fleeting, “Maybe she has learned something new I didn’t know,” even though that was an absurd thought. No more absurd thoughts. Act first in the mom’s safety behalf… ask after. (Always so many lessons!)

The midwife and her apprentice cleaned up, we did the newborn exam… the baby weighed almost 9 pounds!

Dad cooked some food for everyone. We ate and then said our goodbyes about 3 hours postpartum.

The baby was a little dusky at one point, but positioning helped her to pink back up again.

During the one day visit, the duskiness had ended (a pediatric cardiologist once told me that sometimes the valves take a little longer than a moment to seal completely… that if they hadn’t in 24 hours, then it is good to have the baby seen) and everyone was so happy. Nursing was going well, the baby was pooping and peeing great, mom was incredibly happy and telling us how thrilled she was with the birth – how each of us had a role to fulfill… including my observing-picture-taking apprentice who helped her youngest daughter when mom said she was going to die.

I am sure I heard it figuratively… the kids heard it literally. Especially after their brother died, it must have been a scary word to hear.

The girls all wrote the birth story from their perspective and are re-writing it for me, saying I can share it with y’all. I am allowed to use names and pictures, too. Mom agreed, too, that I could share the children’s words and faces. We read two of the stories yesterday and wept… I can’t wait to share with y’all!

I am so thankful this birth went well. My apprentice’s first two births with me… a 26 hour transfer to the hospital and then a few hour gorgeous homebirth filled with emotion and love for daughters.

Such a beautiful joyous life I really do have.

Cesarean Birth

This couple has had their share of difficulties in birth.

The first birth ended in a cesarean after many, many hours of labor. While mom was disappointed, she was happy she had a healthy baby girl.

Pregnant the second time, she didn’t even consider a VBAC, but scheduled a cesarean so she might have some control over the situation… not being so exhausted and having it happen so fast. During the cesarean, she was thinking, “this isn’t so bad… I could do this again,” and her baby was born and he cried, but then things began going terribly wrong. The baby, in the warmer, wasn’t being brought to her… a nurse kept coming back saying, “He’s doing okay,” and after the second time, she knew something wasn’t right. Hoards of people came and surrounded her son before a nurse came and said he needed to be taken into NICU right now. All she saw of her son for 48 hours was a white hat leaving the room she couldn’t move from.

Her son had serious cardiac issues that required surgery to repair (several surgeries) and he was quickly airlifted to the nearest large children’s hospital hundreds of miles away. Mom checked herself out of the hospital 48 hours postpartum and drove to the baby where she didn’t leave for 4 months.

Sitting in the NICU next to her baby, she realized she hadn’t gotten a prescription for any pain meds, but a nurse took pity on her and fed her Vicodin to quell the intense physical pain.

Nothing could quiet her emotional pain.

Eventually her son got well and came home, needing to be watched a lot, but doing very well considering everything. Mom pumped for a long time, extending past the NICU time, but never was able to nurse her son.

She waited 5 years to consider pregnancy again. During that time, she became a serious VBAC proponent and knew she wanted a VBA2C. She came to me wanting to have a home birth, but her husband, understandably traumatized from the last birth, really felt it wouldn’t be the best idea and wanted her to have a VBAC in the hospital. After a lot of discussions, she decided to change to a physician that would support her desire for a VBAC (one I have had success with before). Resigned to the hospital birth, we began planning her VBAC (I was to be her doula).

Earlier in the pregnancy, an issue arose with the baby’s kidneys. Now, it isn’t unusual at all to have dark spots seen on ultrasound early in the pregnancy when looking at the kidneys. The fetus usually outgrows it, but her baby had not.

Sent to a neonatologist, he was a complete asshole to her. This mom probably knows more than many NICU nurses about medical complications in babies and this doctor talked to her as if she was the village idiot. She explained her knowledge of the kidney issue and he was insulted she would know what she did… that he wasn’t the one to tell her any information. He skimmed over talking about the kidneys and had to be reminded more than once to focus on them and not her pregnancy and how she HAD to schedule a cesarean for her child’s safety.

During a late ultrasound, the baby was oblique and the umbilical cord was dangling at the mouth of the cervix. She began seeing that a cesarean might be likely and we quickly began choreographing a cesarean that offered the most control over the situation. She emailed me her birth plan which included NO HATS. I gently explained that the baby had to have a hat and to choose a hat that she could live with. She understood and set out to buy several choices.

As with my other mama who wasn’t sure when she would believe the baby was here to stay, this mom said crying wasn’t going to cut it to let her know he was fine… she wasn’t sure when that would happen, perhaps when he nursed.

Another ultrasound showed the baby breech and mom, at 36 weeks, was ready to have the baby… the cord was still down under the baby’s bottom. Her doctor said she’d schedule her for a cesarean no sooner than 39 weeks and my mom had a fit (rightly so). What is so funny/odd about this is in a typical situation, we would LOVE a doctor who wouldn’t schedule an early cesarean, but in this case, mom had good reason to fear her baby’s safety and she insisted, with my support, on having a cesarean sooner. The doctor said she would only do it if she had an amnio first to see if the baby’s lungs were mature (mom was 37 weeks at this time), so she went in yesterday for an amniocentesis. After explaining that an amnio is easier/safer later in pregnancy because finding a pocket that isn’t near a fetal part is easier, mom was reassured.

When we talked about it, I off-handedly said, “What’s the worst that could happen? Your water could break and you would have a baby.”

I got a frantic call from dad that said, “Her water broke! She wants you now.” I said, “I’m on my way,” and flew out the door, getting to her in 20 minutes (a usual 45 minute trip!).

The sono during the amnio showed the cord still below the baby and the baby was oblique; a dangerous situation for sure. The amnio went well and mom was resting, semi-reclined, in bed with the monitors on and 10 minutes after the procedure, her water broke with a giant gush.

Things went into fast forward as a cesarean was going to happen sooner than later. When I got there, I saw she was having some decent contractions and she said she’d woken up with contractions and let them come and go, feeling them knowing the baby was choosing his own birthday. She glowed!

She was so, so thankful she was in the hospital and lying down when her water broke. Her greatest fear was a prolapsed cord and we discussed, several times, what to do if her water broke and she was alone. (She initiated the repeat discussions… I initiated the first one.)

A short segue:

This mom and her family are Disney freaks as much as my family is. Equal in every way. They brought their 5-year old son to a prenatal one time and he and I discussed Disney World as if we had visited together and gone on the same rides thirty-five times. That child knew the details I did and his mom and dad joined in as we discussed our favorite things; many, many in common. This family goes to Disneyland and Disney World as much as we do… a surprise connection we both reveled in. When I got to the hospital, she had not planned to have a baby that day, so didn’t have the cd she wanted to birth to… Reflections of Earth from IllumiNations at EPCOT. It is hard to explain, but this music is so powerful and we have seen IllumiNations so often, we can “see” the entire show just by listening to the music.I know this sounds so crazy to many of you reading, but when I went to Disney World recently and couldn’t get there until 9:00pm (when EPCOT closes), I used up a ticket to get into the park to see IllumiNations… standing there sobbing listening to the music and basking in the beauty of seeing the show live. Reflections of Earth is so powerful, punctuated by lasers, cannons of fireworks, glittery fireworks and a three-dimensional globe in the center of the lagoon that displays everything from a baby’s crawling to a montage of walking feet around the world… so hard to describe the utter beauty of this show.

Mom was very upset she didn’t have the cd, but I thought, “OH MY GOD! I have this on my iPod!” and told her and she was ecstatic! Laughing, she said, “The only other person who would have Reflections of Earth in her possession!” I pulled out my earphones ($200 ones that block out everything else) and turned on Reflections of Earth for her once she was ready and she closed her eyes and went to EPCOT for a few minutes. I was so, so happy I could do something to make her experience happier. She visibly relaxed and when she was wheeled into the OR, she was smiling.

While we waited for her to get the spinal, her husband dressed and then sheepishly looked at me and asked, “May I listen to Reflections, too?" Smiling, I pulled out the headphones again and played the music for him as he sat, eyes closed, also transported to EPCOT. He thanked me so much for having it and when he went into the OR, he, too, was smiling.

She’d asked me to listen to it during the surgery (they wouldn’t let her take the iPod into surgery), so I sat in the room listening for her.

Her beautiful 8 pound son was born during a crescendo of fireworks and shortly after, he came back into the room with dad. Mom followed after 20 more minutes, both “recovering” in the LDR room she’d started out in. Very different from many hospitals that separate mom and baby during recovery. Very nice!

Her son wanted to nurse when he arrived and was delighted to be held to latch onto mama’s nipple within moments of her return. He nursed for 40 minutes. I held her son and helped her with her breast (after asking, of course) so she could remain flat and still nurse him. She saw that he was wonderfully alive and well and would not be taken from her as her other son had.

She will see a pediatric nephrologists soon, but he looked so wonderful, the pediatrician didn’t think it would be a serious issue, at least at this time. Good news, for sure.

Three babies in four days. 1500 miles in a week. I am pooped! But gloriously happy.

All mamas and babies are well and happy.

What more could a midwife ask for?