Wednesday, August 15, 2007

A Birth Unfolds in Photos & Words

Needing to change to a hospital birth late in pregnancy, my client was able to change to Dr. Wonderful who works at one of the two Baby-Friendly hospitals in our city. His promise to help her have a marvelous natural birth in the hospital wasn't bullshit; his words are Truth.

This first picture, however, demonstrates what occurred when mom was admitted to the hospital. The baby's baseline fetal heart tones were about 100, albeit somewhat reactive. FHTs during the pregnancy were 140's-150's, so 100's were somewhat disconcerting. Dr. Wonderful was called in.

This photo shows mom's sister laying on hands and giving loving energy. Mom is talking to the baby, letting her know she is safe and all is well... dad, as we can see, is concerned, but hanging in there. Mom has oxygen on her and technology all around.

The (wonderful, amazing) nurse (we had) did a vaginal exam and found mom to be 3 cm. The nurse and I began preparing mom for a cesarean - physically and emotionally. I explained the cesarean procedure, the epidural... and the nurse said the anesthesiologist would do a spinal because the spinal would be faster... and I explained things to dad, tried to get his garb for him to put on, but we were busy getting consents signed and all. Waiting for the doctor seemed endless. Fetal heart tones were dipping into the 90's and not getting any higher than 110 with accelerations. I kept calm, but was clear and sharp with the information.

My dear doctor was on the phone at the nurse's station when I went out to go ask his ETA and our nurse said, "Do you want to talk to him?" and I emphatically said, "YES!" before the other nurse hung up and said he was on his way in.

Dr. Wonderful floated into the room like a silk scarf on perfumed air, filled with more confidence and hope than I carried - more like a midwife than I was at that moment.

He did a vaginal exam and immediately, the baby's heart rate jumped to 148! She loved his touch on her head. Oh, and how I did, too. Mom had also progressed to 6 cm. in the last 30 minutes. Amazing!

Tears fell from my eyes as I watched the baby's heart rate settle back down into the low 100's (90's/100's) and the doctor suggested taking a whiff of oxygen every few minutes when she felt like it instead of keeping it on all the time like she had been. He also told her she didn't have to lie on her left side... to move wherever she wanted to - oh, how she wanted to be on her hands and knees! He said the baby was just low, having a vagal response and there was no need for a cesarean at all.

And me, thinking he needed a scalpel. How precipitous I would have been as a surgeon! Thank the goddess it wasn't me making that decision.

The entire labor, my client was extremely vocal, so much so that at one point, the people next door banged on the wall, presumedly to make her be quiet. She, so high in her Laborland (her word), made passing notice, "What's that?" - not, "Oh, am I too loud?" I was so friggin' amused, I joined her howls, getting even louder than her for a few contractions lest she be worried at all about the sounds (she wasn't). No nurse came in to tell her/us to be quiet - that she was scaring the other women or that she was using all her energy in the wrong way or anything. She just howled her baby on down. Yummy!

And so mom moves onto her hands and knees... squats at times, rocks at times... even once jumped up onto her haunches from hands and knees!

I love, Love, LOVE this photo. It speaks of the beauty a hospital birth can actually attain when given a chance with the right doctors, nurses and hospital. And supportive midwife as doula.


Because we thought she would need a cesarean, we had mom take off her gorgeous Hawaiian dress and mom was then naked. The great nurse handed mom a hospital gown once mom knew she was going to stay laboring in that room and she promptly took the gown, put it in front of her and puked all over it. I thought I was going to pee in my pants from laughing so hard. No one ever offered her another gown.

Dr. Wonderful and Nurse Fantastic are seen below with mom as she feels her baby's head as it descends into her vagina. The doctor is on her left side, on the bed; the nurse, kneeling on the floor. Most of the time, I was where the nurse was, but occassionally moved to take photos. Notice that mom's belts have been removed... this is easily many, many minutes before the birth. We/I held the monitor to her belly instead of her having to contend with the strap at the end. I held the monitor on her belly for most of labor so she was able to move around, too. I much prefer hand cramps to a mom's immobilization.

Mom had a couple of exams. The nurse asked to do an exam when mom had an urge to push, but I discouraged it, so she went away. When mom thought she was pushing, I asked her to feel for herself and she felt for the head and it was, indeed there. I couldn't see (my head was down under her, lying on the bed), so Dr. Wonderful just rested his hand on her perineum for one second and said, "Yup, baby's right there," and removed his hand.

I was inches away from mom's perineum as the baby was coming towards the earth and this was the last photo right before Dr. Wonderful put his hands in the way and covered the head as the baby was being born. (I'm going to have to speak to him about that!) This series of minute forward motion head shots is so incredible because I can see the capillaries stretching/breaking in mom's vulva as the head descends. Who knew all that happened!

The baby girl, tightly squeezing out... her head had been suffused, so her body is quite white. The doctor does have gloves on, but they are surgical gloves, so it almost looks like he doesn't have any on at all. He is not pulling her at all, but allowing her to come out all on her own. He is very gentle on "his" babies... allowing them to do their own thing and never pulling on them. In fact, I was more concerned about a stuck shoulder than he was. He smiled at me when I put the camera down and asked if he needed help. I'm laughing at how funny that must have sounded to him now, but at the time - and how accessible he is to me - it doesn't sound absurd at all. He just smiled and the baby came out nice and slow... slipping out roll by roll by roll... all 8 pounds 8 ounces of her.

Before the baby was born, the nurse came up to me and asked, "Does mom and dad want Vitamin K and Erythromin for the baby?" and I answered they did not and thanks for asking. She didn't bat an eye and nothing more was said about it. When things got closer, I let mom and dad know things had already been covered regarding the baby. They were glad they didn't have to do it. Me, too! How cool to have a nurse come to me, eh?

Because the baby had a tight squeeze and because there was a goodly sized caput, I was wondering if the baby might not need Vitamin K after all. Dr. Wonderful checked the baby over and said, "Nahhhh, she's fine."


Do you see the doctor in this picture? He's the one not in scrubs. The one in the yellow shirt.

Dad wasn't sure about catching, was going to help me catch when we were having a homebirth, but wasn't so sure about it at the hospital. Once there, though, I'd talked him into helping the doc and even had him practice washing his hands with the fancy foot soap and water thingie at the sink. Once the doctor was there, though, he was more nervous, but as things got closer, I put my midwife voice on and said, "You will only birth this child ONE TIME, so I HIGHLY suggest..." and that was as far as I needed to go before he jumped up and washed his hands and got ready to help the doc catch his baby.

The picture below is the beautiful photo of dad (who does NOT have gloves on, thank goodness!) assisting Dr. Wonderful with his newborn daughter.

In 24 years and 8 months of assisting women in birth in the hospital, I have never seen a woman birth on hands and knees. I've never seen an OB or a CNM allow a woman to birth in the hands and knees position. I have never seen an OB do a vaginal exam on a woman in any position except on her back until this birth when this doctor did a vaginal exam with mom on her hands and knees. I actually wondered if he could even find her vagina with her on her hands and knees! He didn't have any problems at all. Shocking. I think I've seen a CNM do a vaginal exam on a woman in an "alternative" position maybe 20 times in all these years, so even that is a sad commentary. I tell women I can find their vagina or fetal heart tones if they are hanging from chandeliers! How did I get so good at it? PRACTICE!

Anyway, so here my client has her baby on her hands and knees... her husband helps the doc catch and it is amazingly wonderful, but now mom needs to see her new daughter. How does that happen?

In most hospital worlds (as if any of the above would have happened in the first place), the cord would be cut, mom would be flipped over, the bed would be broken, mom would have her feet placed in the stirrups so she could have her vagina checked and she'd get her baby that way.

Instead, Dr. Wonderful, who's not wearing scrubs and only a pair of surgical gloves, doesn't cut the cord and knows how important it is to just give mom her kidlet says, "Okay, mom... here comes your daughter... ready?" And then passes her between her legs.

I love, Love, LOVE that I have this picture! There won't be many times in my life that I will have a photo such as this. This is a DOCTOR (I know, I shouldn't be shocked anymore, should I? But I am. I am mostly shocked that I am blessed to be in the same room and photographing such an awe-inspiring event that brings hope to hospital birth everywhere).

Nothing needs to be said about a mother's love. This picture is my desktop right now. I think this is one of the best pictures I have ever done showing a mother and child. I get shivers just looking at it! The shadows are perfect, the lights... the IV... all of it... her daughter isn't even 3 minutes old in this picture.

I end the series with a tender surprise photo I took of Dr. Wonderful with my client. He embraced her, then she him. He with tears in his eyes and both of them whispering thanks to each other.

To have witnessed the cruelty and evil of so many other (un)care providers in over two decades of birth work, I splash in the absolute pleasure of experiencing birth in a hospital with my guard down, not worrying about saving my client from having her birth plan ripped to shreds or having her baby taken from her by Child Protective Services for being one of "those" mothers. There's always so much to watch out for in the hospital... we all have to be Cerberus to feel safe (and even that isn't nearly enough, now is it?).

So, it just seemed so important to demonstrate how it CAN be. It might not be for anyone else in the world but this one mom - or the moms who get this one amazing doctor - but if this one man can exist, then there is hope in hospital birth. It doesn't mean hospital birth replaces homebirth at all. My client needed to birth in the hospital for a very serious reason and she was so amazingly gracious about moving to the hospital to deliver there. So, if some women do have to deliver in the hospital... isn't it a good thing to have hope?

I live for hope.

Baby Madeline Joyous was born August 12, 2007 at 2:41 am after 6 hours of labor.

She is gorgeous!

(more pics of the baby to come when I take some)


Maiasaura said...

That was a beautiful story. The pictures near the end brought tears to my eyes. He does sound like a wonderful doctor, truly!

Amanda said...

What an amazing story... and photos. How I wish I had this doctor when my son was born...

Aubrey said...

This is so wonderful. I am just pregnant-blubbering away. I wish I could meet this Doctor. I wish there could be more like him.

Tara Przybille Bradley said...

I do hope that you and the mother have communicated to that doctor how valuable and amazing he is!

And what a heroic mom and dad!

And last but not least, you! How beautiful you are to do what you do.

MsMoo said...

wonderful story. Likewise, I hope Dr wonderful knows how valued his paradigm is in the hospital system to us birthing mothers. Wonderful pics, thanks mom.

Mary the Birth Goddess said...

I just realised how old this post is- are you not sharing stories online anymore? please continue to share. This one was so beautiful- I have NEVER seen a hands-knees birth in a hospital- wonderful!!!!!!

K said...

Thanks for posting on my blog. It lead me to yours. What a fantastic birth story! Can you email me privately and tell me more about this Dr. W and what city this took place in?

I'm a trained doula and sort of lay midwife for a friend who chooses unassisted birth. Her last two babies she delivered on her hands and knees, one in the hospital* (gently induced with another doctor wonderful, but he was checking out his hands in his lap while I was catching the baby. He looked up and said, Oh! *She carries them all 41-43 wks) and the last baby was 10 pounds 6 ounces, born at home with me helping. There was shoulder dystocia (hand by an ear), but I'd already had a vision of it several days before and I'd taken Ina May Gaskin's seminar on breech and shoulder dystocia so I knew what to do and it felt like I'd done it a hundred times before. I had my friend try the Gaskin Manuver but it didn't work and then try with the other leg. I'd noticed a bit more give with the first leg so she did it again and I reach into her and braced the baby's upper arm with my two first fingers and gently moved the shoulder so the baby could rotate. It was all under three minutes and a few contractions.

I have heard that OBs and nurses have the highest birth intervention rates, but didn't realize so many choose elective c-sections. That really offends me. Especially to say the baby is better off.

A friend of mine, a pediatrician, had hospital births, but natural ones, didn't circ and tandem breastfed. She must be an exception.

hearnoevil said...

Who is this doctor??? I want to know. How wonderful.

Navelgazing Midwife said...

Live in San Diego? If so, I am glad to share who he is with others. Otherwise, I'd rather not advertise him on the Net. I'm sure you understand. :)

Rebekah Costello said...

I just have to say that I have tears running down my face from reading/viewing your re-caption of this beautiful birth. Thank you so much for sharing this! Wow! It brought back some wonderful memories of my own births and honestly, that guy needs a medal! He's amazing, we need more compassionate, fantastic ob's like him!

I can tell I'm going to love your blog already.

Navelgazing Midwife said...

I have another blog... much more up-to-date and midwifery relevant here:

Come read there, too!

Rebekah Costello said...

Thank you, lol, I have this one bookmarked already. I've been reading you for a few months. I didn't realize this was you, though.

tropicana said...

Wow, if only all women had the option to have this beautiful of a hospital birth....I didn't know it existed! Thank you for sharing.

Anonymous said...

Trish CNM says: I have attend many births with women in hands and knees position in the hospital; it's not about the location for the birth; it's about the mother and her provider!

Jessica said...

Wow, everyone seems to be so shocked to read this story, yet to me this is just a normal day for a birthing woman in Australia in hospital. I'd say less than half of women actually birth in a semi-recumbant position on the bed. The rest birth either hands and knees, on a birth stool, on a mat... whatever they want! At the hospital I work in, we delay cord cutting and simply pass the baby to the mother regardless of her position.... all the doctors do the same. Women NEVER EVER birth in stirrups... ever. I feel sad knowing there are other places in the world that DON'T have these simple options available to women if birthing in hospital. We try to make our hospital births as natural to home births as possible. We have showers in all rooms... some have baths as well... we play music, we have massage oil, we have birthing balls and birthing stools. A bit of everything really. Lucky country I guess :-)

Vanessa said...

This post has a lot in common with my daughter's hospital birth - she was also an unmedicated hands and knees birth, and was passed through my legs. I was with a CNM though. :)

Doula Kate said...

Thank you so much for sharing this beautiful story! I loved reading it and the pictures really make it special. What an amazing, sacred journey!! I love seeing positive stories of hospital birth - they are possible!!

Anonymous said...


The Mom I Want To Be said...

Beautiful Story! I recognize this awesome dr. from a video I just saw yesterday on youtube!!

Midwives Naturally said...

Even nearly 4 years on, these stories inspire and touch people's hearts - Thank you