Monday, December 25, 2006

December Birth # 3

Mom called me and told me things were starting and I called my assistant and asked her to come to my office, half way to the mom's house from hers, and and sent my apprentice home to take a nap and asked her to come back a few hours later and we waited. And waited.

Those who have read here for any length of time know that if I stay the night at my office, the woman's labor will surely peter out and I will have spent the night for nothing, but if I go home to do anything, her labor will speed into overdrive and I will have to pick my head off the pillow and drive back half-asleep. Weighing what to do is one of my biggest challenges when a woman isn't in full active labor.

We sat on my princess bed (well, two of us did, my pregnant apprentice sat on the camel chair) and talked as the afternoon darkened the room and we giggled and yacked about all things midwifery and relationship. How can three women talk so much about birth?! We ask ourselves that everytime we see each other. Do we ever get bored? Never! It is so nice to finally have someone with whom to talk incessently to. Finally. Our families sigh with overwhelming relief.

Dinner time comes and mom feels contractrations are about the same-only-less, so says we should go home and she'll call me in the middle of the night. I sat there on my triangle point trying to figure out which side to go down... stay at the office (20 miles from her house) or go home (55 miles from her house). The girls tried to help, but they were as undecided as I was.

We decide to go to On the Border. You see, On the Border is our restaurant of choice when a woman is in piddly labor that is sure to kick into high gear as soon as we are served 1) drinks 2) dinner. This has happened no less than three times and we laugh that we need to go there when we are in that odd place trying to figure out if we should stay with a mom or go home... "Where's there an On the Border?"

My apprentice lives kind of on the way home, right by the On the Border, and the other lives past where I live. After dinner (where we didn't hear from the mom at all), I took them home with me thinking she was surely going to call, but, once there, she called and said she was going to bed. Each woman called a family member to come and retrieve her from my house. I went to bed the moment they left.

About 2 hours later, the dad called and said things had picked back up and we should think about coming now. It was 10:30pm. I called the girls and got myself together and drove to pick each of them up (neither of whom had slept) and got to the mom's house about 12:30am.

Labor was ineresting. When we talked on the phone, mom said her contractions were every 5 minutes lasting a minute or so, but they were much shorter than that upon observation... maybe 20 seconds. She had to concentrate for a very short time when she had contractions. This was her second baby, but she'd had an epidural and pitocin for the first, so it is, for many women, almost a primip birth. My apprentice and assistant set things up while I assessed the contractions and figured we had a long night and day ahead of us.

Mom was in good spirits and dad was very excited. Their daughter, still nursing, was sleeping. She didn't have an in-depth relationship with dad, so mom had to tend to her when she would awaken. Dad did a great job trying, but mom, in the end, had to go and nurse her back to sleep. We wondered if this affected her labor progress. I believe it probably did.

There were a couple of requests from mom and dad: dad did not want to catch the baby and mom wanted the baby cleaned off before being handed the baby. Not mine to question, just mine to follow.

During the pregnancy, the daughter took a serious liking to my apprentice. I mean, such a liking that she (the daughter) thought I was the assistant and my apprentice was the midwife (it was a great opportunity for her to take a very active role as the lead midwife)! Pretty early on in the care, I'd decided that this would be my apprentice's first catch and a couple of month's ago, let her know it would be. She was demure and sweet and said such kind things like, "This isn't about me, it's about the mom and baby." I would have been all giddy and happy about my first catch, but she wasn't and I thought it was interestingly odd, but shrugged and thought it was just her quieter style. I tend to be more noisy. Surprising, I know.

I needed to sleep, so the "head midwife" spent the night awake with the mom and dad as I slept on the couch a few feet from them. The assistant slept in an adjacent room (where the birth was going to occur... not the bedroom, where the toddler was sleeping). Every once in awhile, I could hear snippets of conversation and got a gist of the contractions... short and sweet... not moaning... I kept thinking, "oh, yeah... plenty of time still ahead!"

About 4:30am, the toddler awoke and dad tried to quiet her, but once that wasn't going to happen, mom nearly jogged to tend to her. I blinked my surprise at her laboring agility and made a mental note of "where would a woman have to be in labor to jog to her child to nurse her?" The dad, who'd given a valient effort, seemed sad that he'd failed.

The apprentice went to bed, the toddler got up, I went to doze on the couch, and the mom went back to laboring in front of the fireplace.

She'd been having some mean posterior-type contractions earlier, so we showed her hands and knees and that position seemed to help. She remained on hands and knees for a few hours and the back pain seemed to subside compared to what it had been earlier when we'd arrived.

I laid on the couch, half-awake, listening to the family interacting - mom eating oranges, drinking juice (she did not like water very much at all, but would drink ice water occasionally) and counting contractions. They were so far apart... and so short. I was sure we were still in such early labor, we could go home for awhile, or at least get out and eat and have some time in a bed before returning.

As dawn broke, I awoke and sat with the mom who pulled in tightly as I talked with her about her contractions being far and short and how they seemed to be in early labor and not as long as she described them. She said that when I wasn't there, they were longer and I said that I believed her! I said that happens often and that perhaps we all needed to go so she could find her rhythm once again and then she could call us when she was about ready to have the baby. I told her I just thought she was still early and would have so much time based on the ebb and flow of the contractions. I offered to do an exam, but knew she would say no because she had expressed no desire for any exams the entire pregnancy and when I needed to do one to determine a head or a butt a couple of weeks earlier, she was less than pleased.

When I woke the apprentice and assistant, we also helped the dad and daughter get ready to go to the store for awhile to allow mom to rest. Her contractions had completely stopped by this point and she was suddenly extremely tired and wanted to go to bed. I thought it was great for us all to give her some time to sleep so she could wake up in labor.

When we drove away, we talked about mom's possible inability to focus on labor with the toddler there - how she literally jumped to her needs and how we thought it was good she was going out of the house, too, for awhile. I thought it was good for all of us to head out for awhile.

We drove down, in morning traffic, to where the On the Border is (45 minutes away), but went to IHOP. We were tired, but talking about the upcoming birth and how nice it will be, how we thought it would be at dusk (we usually see births shift at dawn or dusk) and waited for our food while we sipped our iced tea and coffees.

Mom called and said she was having a feeling like she had to pee every few minutes, like with the contractions, was that normal? I said, "Sure," that she might feel it lying on one side more than another and if her bladder is full. She said she was still resting. We still waited for our food. What was taking so long?

Just as our food was being set down (and damn we were hungry), mom calls and tells me she feels something in her vagina... a bag or something... and immediately I know, the baby is coming - and I won't be there.

The girls hear nothing coming from me, but see my face and I begin digging in my wallet for money and I throw $40 at the assistant and begin slowing and calmly talking to the mom about what she is feeling so I can talk her through this. She is alone.

My thoughts that fly through my head in one flash:

You ass! She's alone. Get her husband back home. Call her husband's cell. Her daughter's gonna freak. Call 911. Offer to call 911. DON'T CALL 911!! Please don't want me to call 911. Stay calm. Please don't be breech. You can do this (the mom). Slow and calm (me). Why am I so fucking far?! I will never make it. Why is it morning traffic time?

And probably a lot more expletives I conveniently forgot.

As the assistant pays, I remember getting into the car, me driving, and telling mom how to stay calm and how to deliver her own baby, that is, by the way, in the caul. I tell the apprentice to call the dad - mom has to repeat his cell phone number about 10 times - and tell him to go home NOW - and that's all he hears and hangs up on her. She calls him back and tells him if he goes in the house and finds a baby, to please put a blanket on the baby, which further freaks him out.

I stay on the phone with mom, talking to her gently throughout while careening through rush hour traffic (sorry everyone) and she moves from the toilet to the bedroom where she wants to deliver and gets on her hands and knees. I reminded her that she knew how to do this instinctively, that she had the power... anything to keep the banter going. I told her I had to offer to her to call 911, but that I believed in her and I knew she could do this alone if she wanted to and that we were calling her husband back to her. I had to let her know I wouldn't make it to the birth, but I wouldn't leave her on the phone.

Dad gets home about 9 minutes after we call him and we talk him through the birth, which happens about 4 minutes after that. When dad got on the phone, I asked him to center and focus because he'd been out in the world and running and he needed to be centered to catch his child. He was fantastic as he took a breath and I could hear him audibly relax.

He kept asking what he should do and I stressed making sure the baby could breathe once the baby was born if the sac was still over the face. He said the sac was coming out and he could see the head was coming out... he was giving me the sizes in coin sizes, but I think they were European coin sizes. As more and more of the head was born, he started telling me the head was purple.

At one point, I thought he told me the baby was born and not breathing and I told him to take the sac off the face and rub the baby's back... I didn't hear her crying (they knew it was a girl)... and I was getting scared. Then he finally said only her face was out and looking at him, I relaxed and said she would come in a moment and as I said that, she was being born and cried right away.

I was thrilled. Can I say now that every pregnant woman should be required to have speaker phone?

They got blankets on her (I'd had him turn the heat on 80 as he ran in the door and turn the heating pads on) and then I told them all they had to do was just sit with each other and wait.

We arrive 19 minutes after the birth. 28 minutes to get about 45 miles in morning traffic - not too bad. Too late for the birth, but we made it for the placenta!

We came in (after calming before entering) and set to work assessing - all was well, but there was some bleeding we had to tend to. The placenta was born with some assistance, mom needed a shot of Pitocin, the baby's cord was cut (it had long stopped pulsating), and we cleaned mom and the bed up before righting the room and getting the things that we no longer needed out of there.

Mom was pretty stunned and it took a couple of days before she was happy with her birth experience. She is proud now, as is dad. Remember, he did not want to catch and she wanted the baby cleaned off before holding her; neither happened. But, he was promoted to midwife and she was the first to hold her child - both are very proud to have been alone when their baby was born. The daughter was scared and ran out of the room at the moment of birth, but she has acclimated to her sister just fine and is even finding a way around tandem nursing.

Amazing what we can do when we have to, isn't it?

So, my apprentice didn't get to catch and even when we were going to have her catch the placenta, that didn't work out either because of the bleeding, but she did get to cut the cord and did that very well (it was her first time). She told me that throughout the pregnancy, she just didn't see herself catching this baby. She'd said that she couldn't even picture the actual birth itself, which none of us could either (and that was odd), but now we know why! I still don't think she'll be as giddy as I was anticipating my first catch, but perhaps she'll be able to visualize it.

Oh, and one final note: Postpartum, I looked over at the bookshelf in the room where the baby was born and what was there but Anne of Green Gables. I laughed and we wondered aloud how many births Anne has witnessed! We know of at least two in a row this December of 2006.

Thursday, December 21, 2006

December Birth #2 - Birth Brought Ailie

Mom had UC'd with her third birth - her first two were in the hospital, the second a total, fabulous precip - all under 4 hours. With this birth, she wanted something different - a different energy - something she wasn't able to completely describe to me, but conveyed to me by hiring a midwife (me) who would play by her rules as long as things were safe and all was wonderful and cool. And all was wonderful and cool, indeed.

During the pregnancy, she agreed to allowing me to draw a prenatal blood panel and listen to the baby's heart rate. Blood pressure and measuring the uterus are not the most crucial things for me, but she allowed us to do those, so we did. All was fine and dandy.

Our biggest obstacle was getting to mom's house before the birth (she lives far from my office and even further from my house) and extensive counseling was done regarding staying close to the ground and not being on the toilet if she was alone during the moment of birth. Mom really felt we would make it this birth and the assistant and my apprentice also felt we would, but I wasn't so sure. I just wanted all the bases covered, so made sure she knew: low to the ground and off the toilet!

She knew labor was going to come soon by contractions that were annoying, but they stopped periodically over the few days before they wouldn't actually stop. Once the didn't totally stop, she still could sleep through them for some of the night, but she walked and wandered and puttered around the new house to keep her mind off the contractions and on other things.

Her best friend, another client of mine - the client of mine that transferred to the hospital and then subsequently hemorrhaged at the birth - spent the day at her house entertaining the two younger kids, feeding and watering her (the laboring mom) and taking cool pictures of her fixing the heater (with tools and everything). The two dads also hung out that day playing poker for some sort of yogurt balls (I'm sure someone will understand what I am talking about) and then when it got closer to dark, the laboring mama thought it was cool to have us mosie over - not that anything had changed, mind you. She'd been in labor for about 17 hours by this time - a new record for her. Her total labor was 21 hours. We were there for about 90 minutes before the birth.

I gathered the troops (I drive them to births when we have time... it's a nice trip back and forth) and we headed up, wondering if we'd make it or not. When we got there, we saw our previous client holding a baby and wondered if it was hers or the new baby. It was her own. The new baby waited inside the mother for the midwife to come.

It was a hootin' party inside! Kids hollerin'. Dads laughing. The tv playing some sort of kid's cartoon. Something baking. How festive! Where was the labor going on?

Oh, there she is. In this side room over here.

We walked over to the room and there's mom hunched over a birth ball watching... what's this? Blinking, I had to laugh outloud.

I've experienced a whole lot of different styles of relaxing in labor. I've written often about how I own every Enya, but if I never had to hear her again in a labor, I would be thrilled. Between she and George Winston, they are my hands down faves for most over-played labor music, although hypnobirthing tapes are outweighing George nowadays.

I loved this mom after spending time getting to know her, long before I was ever her midwife, but what she chose to watch in labor sealed our fate as "kindred spirits."

Anne of Green Gables & Anne of Avonlea

Yes, it's true. She spent her labor watching the tales of Anne Shirley and Gilbert Blythe and life on Prince Edward Island, Canada.

Suddenly, I knew we could be lifelong friends if she could/was watching this movie in labor - in deep and heavy labor! A woman after my own heart.

We pulled in the supplies from the car, but most of them stayed in the living room or dining room and we brought in just the actual birth essentials (gloves, clamps, mirror, flashlight, etc.) and got the blankets warming on the CPR board (that we surround by two heating pads). We ended up taking one set of vitals and two sets of heart tones on the baby and that was it because all was fine - and things progressed quickly.

After the initial shuffling of bodies into the room, we got settled: I was on the bottom bunk with my apprentice, the assistant close to the tv, the mom on her ball or kneeling on her ball in the center of the room, the friend wandering in and out and the kids doing the same.

Eventually, the one dad left with the friend's kidlets and the youngest child of the house fell asleep so dad put her to bed.

Now, this dad wasn't going to have a part in this birth. We assumed it was cultural and it very well might have been, but it was also a pretty big assumption on our part. He'd left for the UC and mom had her friend (the same one that was here this time) there to catch and he came back when everything was cleaned up. That was the plan pretty much for this time, too, except this was nearing midnight and there wasn't anywhere to go with two sleepy kids. Near the end, he stayed in one of the back bedrooms (I think).

The saga of Anne continued as tension between her and Gibert rocked back and forth - much the same as my client on the ball, although she barely moved or breathed differently than you or I are doing even now. If you didn't know she was in labor, you might not have even been able to tell. She got up and waddled to the bathroom every few minutes - the most obvious strenuous part of labor looking at it from the outside.

Many women's contractions are regular and rhythmic, but this woman's were, down to the second, 5 minutes apart from when we arrived. When Diana Barry got married, her contractions moved down to 3 minutes apart and her breathing quickened slightly - eyes closed more time than opened - and we could see things were coming closer.

You know in poems and stories how Death is spoken about like a person or an actual being? How Death walks in the room or you can smell Death? (I hate having to talk about that like this in the middle of a birth story, but there is no other way to talk about this but this way.) Well, at this birth, Birth walked in the door.

Never, in all these years of working, have I ever, ever, ever experienced such a tangible moment of clarity that Birth was imminent without any outward signs to tell me so. There was no bloody show. There was no pushing. No contraction. No grunting. No sighing. No crying. No words from mom at all. There was one thing only.

Birth walked in the door with her arms filled with the scent of herself.

As if we'd been sitting in pitch black (no scent) and someone (Birth) turned on the lightswitch, the scent of birth was not there and then, just as suddenly, was so pervasive my head swam in the headiness of the scent of this woman's oceanic wetness that hadn't even spilt a drop anywhere outside of her vagina yet. I looked at the women around the room.

My apprentice, my assistant, the friend/my client - did I say outloud, "I smell birth"? or did I just say, "It's time to wash our hands"? Somewhere before or after washing my hands I sat on the floor and turned the tv off while the friend turned the video camera on and we hunkered down on the floor and watched as mom's amniotic sac burst against the back wall and she laughed thinking that was big fun. 4 minutes later the baby was born.

On hands and knees, mom let the baby come down and we watched as she came down somewhat acynclitically (thank goodness she was small!) and I encouraged mom to reach down for her baby and she got one hand down, but couldn't quite help her up so the assistant helped the baby out and up through her legs so she could bring her baby up to her own chest.

We brought warm blankets over to let mom dry the baby - no hat! (I have this thing about babies and hats, you know, and this mom didn't want a hat on her kid. At the home visit, I said that I really wanted a hat on the baby since it was going to be cold and she said, "that's nice" to me. I just laughed, knowing where I was going to go with any further hat discussion.)

Dad heard the baby's cry and walked by the room and said something like, "already?" and then something along the lines of "yuck" before walking away. We closed the door so we could get things cleaned before he had to see the baby again. Closing the door also made the room warmer.

I'd made a concession (my own) about the hat by bringing an extra space heater (I carry one in the winter anyway) into the room and we had it going along with their space heater. About 5 minutes after the birth, a fuse blew and there was suddenly NO heat in the room at all except by all of our body heat. I had to laugh at all my planning ahead. Someone tossed a big blanket on top of mom and baby and I hoped for the best. I was glad we weren't in Minnesota.

We cleaned things up as mom was fed and juiced and then she trekked to the toilet where she said she knew she tore. I asked if I could look and she said, "nope," and I said, "you won't let me suture if you tore where I could suture and make you more comfortable?" as she sat wincing her face all scrunchy on the toilet. "Nope," she said. Eek! Okay. breathe

We cleaned up the room, got the bed ready for her to climb into as the dad got the fuse thingie fixed. I checked over the baby really quickly (with mom's permission) while she was on the potty and took her temperature (she was a girl!) and it was a chilly 96.9. I expressed my concern about her temp and wrapped her up warmly and suggested a skin to skin and under the blankets once they were together again. I kept her close to me until mom got back.

We loaded our gear back into the car and headed out a lickity-split 90 minutes after the birth. Only one other time had I left that fast after a birth - after my now-apprentice's hands-off birth, It still felt bizarre. So much was left undone! I charted "mother refused" on the newborn exam, the vitals, the measurements, the postpartum instructions, the place where it asks if mom had a tear or not and whether she was sutured or not. So many things normally/typically done that just weren't done. I marvelled at my groove and how I squirmed stepping out of it. I'm sure it was a great lesson for me to experience. Couldn't have been with a better group of women, that's for sure.

So, after the birth, in the room, there was me, the mom and her new daughter, the friend/my client, my apprentice/client, my assistant, and the new mom's daughter and we were giggling and having a sweet time when the husband tried to get the older daughter to go to bed. There was way too much energy to get that to happen, though. I laughed thinking of all that chick energy zipping around in there and what an honor it was to be lathering ourselves in it... how very blessed we were to be invited into this woman's space where she opened her door and showed us the room where she let Birth walk in and set down, right on her lap, a beautiful baby with the middle name of "Anne."

December Birth #1

Mom had had a great birth experience at a local birth center for her last birth, but hated the car ride down there. She'd arrived at 8cm, pushed for 90 minutes and was there a mere 3 hours before the birth of her baby. She was going to birth in another birth center this time, but nearing the end of the pregnancy, her doula suggested a homebirth and she was off and running.

We met and I was one of three midwives she interviewed. Another midwife told her how horrible the birth center was she was that she was scheduled to birth at, how high their transfer rate was to the hospital, how high their cesarean rate was, how residents practiced on the unsuspecting women in the center... all untruths I corrected and told the woman I had worked many times as a doula and with transfered midwifery clients both in the birth center and the hospital and that she had a wonderful possibility of having the exact birth she wanted to have - including having her daughter jumping on the bed if she wanted her to. She was very relieved and said it was my lack of need to make the other guy seem evil to make myself seem angelic that was one of the things that sold her on choosing me. I told her I nothing to lose (or win) in telling the truth - my goal was for her to have the birth of her choice wherever and with whomever that might be.

She began co-care with me at 36 weeks of pregnancy.

She told the CNM she was seeing she was going to have a homebirth and didn't get a ration of shit (which was nice and doesn't always happen) and kept up her weekly appointments and then had one NST/BPP that went fine. She was scheduled for another BPP, but was debating going to that one - went into labor instead.

During her last labor, she had a doula that helped her so much. She said she was so motherly and kind, she really wanted her again and looked forward to having her join the team. I told her I would love to have her along. I knew the doula's name from the birth center - and had actually relieved her once during one of her long births - but we'd never really interacted before.

At the home visit, we did our usual routine of finding where things are, talking all about the birth, discussing expectations and doing a prenatal. My home visits tend to take about 2-3 hours. Way too long, probably, but that's the way it goes.

The doula was pretty quiet during the home visit, asking a question here and there, but nothing really dramatic.

During a prenatal visit, we knew there was a serious misunderstanding of what a homebirth midwife is and does when the question came from the doula via the client:

Will you allow the cord to stop pulsating before cutting it?


Can you wait to put the eye ointment in until the mother and baby have bonded?

I thought, "uh oh."

I called the doula after that prenatal visit, but she was out of town and wasn't able to call me back and the next time we spoke was at the birth.

Dad called me early in the morning after we'd gotten a full night's sleep and I went to pick up the assistant before heading over to mom's house. This client lives really close to me - an oddity in the clients I have - and it was nice I was still at home and not at work where I'd have been over an hour away.

Mom was in the tub, the doula was working with mom and dad was there, too. The young daughter was playing around the house aswe began setting up for the birth. Contractions were about 5 minutes apart. We didn't anticipate a very long labor since her last one hadn't been so long. Mom was communicative between contractions, but we could all tell she was sure working and concentrating on her work.

It was crowded in the bathroom, so dad took the door off and it was easier for us to be in there together, even though there wasn't much call for all of us to be in there at one time unless the birth was going to be in there. Later, it kind of sucked that there was no door because I had to go to the bathroom and there was nowhere to go for privacy. I thought about propping the door, but that wouldn't have been enough of the type of privacy I would have wanted. If you get my drift. And I think you do.

The dad off and on played with the four-year-old daughter who was very well-behaved. We'd talked prenatally about having someone there specifically for her, but they didn't ever do that, so she tended to talk to us and her dad. She was respectful of her mama's space and experience and we did explain things as we went along, but it would have been good to have someone there just for her, too.

Prenatally, mom let us know she wanted the doula to take a major supportive role and that was fine with us - we let her know we would stay out of the way and let the family do their thing and be there when they needed us. In retrospect, I should have been more clear - and will be in the future. The doula, it seems, sometimes felt the birth and birth space was hers to direct and it was frustrating. The mom never felt anything amiss in her birth (thank goodness), but between the doula and the midwifery team, there was a definite tension.

It was important to us to keep the tension from affecting the labor and birth, so removed ourselves where possible and allowed things to remain stable and calm without the odd rocking that came when more than three of us women were in the room at any one time.

An example: Mom asked that her hair be braided and the doula was brushing it and attempting to braid it. The mom also really needed her lower back pressed during contractions which was the main job of the doulas until she began braiding hair, so I send my apprentice in to press on mom's back until the hair braiding was completed. The apprentice came out and looked at me saying she wasn't needed and I went in and saw that the braiding was abandoned and the back pressing resumed by the doula - a territorial movement that was so unnecessary, but one that was repeated until we figured out what was going on and ended the game mid-action by not playing anymore. Just by acknowledging what she was doing, we were able to not get in the middle of it.

The labor was beautiful. It unfolded so gently and peacefully. Mom moved from the tub to her bed and barely sighed her contractions through her body. Sometimes she hugged her birth ball and others she laid on her side, curled around her pillow. Always, the doula was there, pressing on her back. Hypnobirthing music played loudly (too loudly for me) in the background.

(Note about the mom: I learned quickly that mom didn't speak up for her needs very often, but when she did, they were very strong indeed. Once, when the doula was at her head, she asked that her husband be there instead; that was a very bold gesture for her. For her to ask that the music be turned down would have been too much of a step out of her stay-in-the-lines personality. I saw none of this prenatally, some of this in labor and a lot of this postpartum. I would have done things a whole lot differently in labor had I known this about her prenatally.)

This was another birth that opened easily with no vaginal exams - no one asked for one or thought about doing one at all.

The dad was hesitant about having anything to do with the actual birth because the first time he'd had amniotic fluid splashed all over him and it wasn't a pleasant experience for him. This time, however, when he was asked, he was ready and willing to be right there to catch his baby. He asked if he should don gloves and we asked if he wanted any and he said he didn't. So, mom on hands and knees, dad got on his knees behind her, and I was there as a guide, because this baby was going to be born in the caul.

The older daughter was in the background and was a tad nervous because mom and dad were preoccupied, but the assistant and my apprentice were letting her know things were okay (note: HAVE A DOULA FOR THE OLDER CHILDREN!).

As the baby was born into dad's hands, I gently lifted the sac over her face as she took her first breath and hollered loudly at the same time. It was great! In one motion, dad caught, I lifted the sac, mom reached down, lifted her leg, rolled over and pulled her baby up onto her belly. It was just great. Mom and dad were ecstatic!

We covered the baby lightly after patting her dry gently (she had a lot of vernix on her) - we had a small room heater in the room to keep the room warm for mom (I love love love having the room heater - women don't shiver anymore with the heater! Hurry for Michel Odent!) and we stepped back.

The doula, however, had her hands all over mom's breast and shoved it into the baby's mouth and the baby latched on within 2 minutes of the birth. I don't think I have ever seen a baby latch on so quickly before. I consider it pretty artificially, however. The doula acted like she was in the hospital - hovering, grasping the mom's breasts, just generally in the space. I tried to get her out of there by giving her tasks - to go get juice and water, but she would run to get those and come right back.

Then came The Bath.

The doula had this brilliant idea that mom had to have a bath with the baby. She'd mentioned it once during labor and I was a little baffled by it because it was the doula asking, not the mother, but left it alone, but now the doula was insisting the mother get into the tub with the baby and the older daughter wanted to get into the tub, too. Well, okay. I explained there would be blood, but if they wanted to do that, it would be fine, just to keep the baby warm. (Initially, they wanted to use the water that had been sitting there! I nixed that and had her draw a new warm bath.)

While the bath was filling, mom had some fruit and went to the bathroom to pee. By 30 minutes postpartum, she was in the tub with her new baby. sigh

I stationed the apprentice at the door of the bathroom with the mom, baby, older child - and doula?

The assistant and I were cleaning the room and were going to start laundry but dad was already doing that. What the heck was dad doing doing laundry? Why wasn't he with his family in the bathroom?

I walk by the bathroom and my apprentice grabs me and says, "The doula says it's okay for the baby to go under the water."

To which I poke my head in the bathroom and say, "Do NOT put that baby under the water! Why would you put the baby under the water?"

Apparently, in the movie Birth Into Being there is an explanation of the closing of the glottus or some such crap and the baby not drowning. Well someone else might want to stick a baby under water on their watch, but they fucking better not put a baby under water based on something they heard from a MOVIE on MY watch on MY license.

My partner said I should have asked the doula to leave the house that very moment. Others have said the same thing.

What I did do, was let her know that one doesn't go by what a movie says to make such serious choices for a newborn. I have since written her a very long letter explaining the liability she put both of us under in doing such an agregious action. I pray she never does that again.

So, the mom and baby get out of the tub and all is progressing normally and about 3 hours postpartum, I begin doing the newborn exam and I get to the part where I examine the base of the baby's spine and what do I find, but an opening. I ask for more lights. It isn't just a dimple, it's an opening. It isn't a protrusion, but an actual going inside the body like-a-dimple-only-much-deeper area above the crack of the baby's butt.

I don't remember the exact order of actions, but they included telling the parents this wasn't a normal dimple, that the baby's legs were fantastically strong and active, which was a great sign, asking for yet more light, trying to see the bottom of the dimple and being unable to, asking for the number of their pediatrician, dialing the pediatrician's number, speaking to the pediatrician and explaining the sacral dimple I found and our discussing the best course of action. I told him her legs were strong and active, but that I did have serious concerns nevertheless. He wanted to know if I had an otoscope and wanted me to see if I could see the bottom of the dimple with it. I told him I did not have one and would not feel comfortable with one if I did because it was that deep. When we were deciding where to take the baby, his office or Children's Hospital, he thought as I did that perhaps Children's was the better place in case a neurosurgeon was called.

The dad had to find a neighbor to take the older child real quick - and no one was home, but thankfully, someone came home just in time or she would have had to stay with the doula or my assistants. It was chaotic for a few minutes as we figured out what to do and where everyone was supposed to go. In the haste, I neglected to direct my apprentice to come along with me. Instead, I instructed her to take the assistant home. I still can't believe I didn't bring her along with me. shaking head

So, at 3 hours and a few minutes old, the family dressed and we headed out to Children's Hospital to get the baby evaluated. The doctor called ahead to alert the hospital and I called them again when we were en route.

When we arrived, they were waiting for us with nametags and we were ushered right into triage, past the full waiting room and the baby was oo'd and ah'd about as her vitals were taken and the dimple was looked at. Mom was standing and I sat her down and had dad stand with the baby, mom filling out the paperwork instead of standing (she was feeling tired and weak). After triage, we were taken into a room where mom undressed her top half and she climbed onto the gurney in there and we undressed the baby and I covered them both with the baby's blankets and the hospital's sheets and blankets to keep them warm and mom nursed her newborn and we sat quietly while they whispered their quiet bonding time. I answered questions when asked and smiled a lot and shared information periodically, but a doctor came in quickly, so there wasn't much time for any small talk.

The doctor came in about 20 minutes after we got into the room and he was very kind and respectful to the family and the baby, asking to touch her, and then looking at the dimple very carefully, not making her cry at all. He had to look and pull deeply to see the bottom and couldn't see it either. He wanted more light, so lit the room and dad held the overhead round really bright light that is the spotlight light we all associate with operating rooms and emergency rooms and he still couldn't see the bottom of the divot. He did not, mind you, take an otoscope and look to see the bottom.

He did, however, say the baby's legs were active and strong and that he could see the bottom of all of the dimple except for one fissure and he'd let the pediatrician follow-up with that. That the ped would surely send them to a neurosurgeon for a consult. I felt a huge sigh of relief that the baby had been seen and then was being released.

We were in and out of Children's Hospital in one hour and 10 minutes and every one of us - from mother and father to newborn to midwife was treated with kindness, respect, and given all the information, privacy and patience anyone could ask for when going through something so scary as facing possible surgery with their newborn.

Mom told me outside the hospital, as we waited for her husband to bring the car around, she didn't know why we had to go, but that when I said we had to go, we had to go. She said she still didn't know what the seriousness of it all could be and I shared a snippet that her baby could have been in surgery at that moment if the spinal cord was exposed and she seemed to understand. I told her how blessed we were to be going home with her beautiful baby. I told her a thousand thank you's for coming in so quickly and readily - it meant so much that she just got dressed and ready. That when she was trying to choose between the pink and purple outfit for the baby and I said, "there isn't time to dawdle" she said, "purple's fine" and she moved with a purpose.

Postpartum, this family has continued being warm and kind towards me. They saw a pediatrician that wasn't their own who barely looked at the dimple and dismissed it saying it was fine. She didn't even touch it! The family asked, confused, has the divot healed? And she said it was just fine, not to worry about it.

When they saw their own pediatrician a few days later, he, too, said that it was fine, but if she had any problems, to let him know.

(If it were me, that baby would be having an MRI, let me tell you! I would not be pacified with such flippancy! It's a baby's SPINE, for crying out loud!)

So, the story ends gracefully with the hospital being lovely to the family, my being a goof forgetting to ask my apprentice to go along to witness a great transfer to a decent hospital, my learning to speak to a doula who hasn't been to homebirths no matter how inconvenient it is prenatally, and I'll leave you with this to make you laugh.

Mom had a few breastfeeding probs that I had to address at odd hours of the day and night, including going over to tend to. I found myself at one time in her shower with her at 5:30am helping to soften her engorged breasts before putting frozen veggies on them afterwards. We spoke several times a day about her breasts for probably 4-5 days. Then I didn't hear from her for a day and a half and I got worried. So I called her. I got her machine. This is what I left on her machine:

"Hey! I haven't heard from you in a day in a half. Are you okay? I'm used to hearing from you. I think about your boobs all day long. Uh, you know... in the good way. Uh..." click

Luckily, she laughed her head off and said she was going to burn it onto a CD and play it at parties - "Hey, listen to this! This is my lesbian midwife!"

I can't stop laughing. One of my Hall of Fame Most Embarrassing Midwifery Moments.

Just gotta keep laughing.