Thursday, December 21, 2006

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.


Sarahthedoula said...

On behalf of doulas, I apologize.

I do understand that if she's only had hospital experiences she might have developed an overprotective and territorial way of being with her clients. But really, that isn't ultimately helpful at a hospital or at home. I hope that she is open to learn and grow from this experience, and that her future doula clients will benefit as a result of you taking the time to write to you her about your concerns.

Kate said...

Loved the boobs message on the answer phone - hilarious. Thanks for sharing these stories, I've just found your blog and will be reading everything :-)