20 Years of Birth Stories

Kyra's Birth Story (written by Donna)

2008-09-25T07:40:00.000-07:00

I was due with my 9th baby on April 22nd. However, since 6 of my babies came after my due date, I knew it was a likely possibility that I would go past my “due date”. So, April 22nd came and went, and I remained pregnant. By this point, it wasn’t so bad. I had gotten rid of a horrendous back pain I developed several weeks earlier, and it was more the anxiety of not knowing when labor could start that I was dealing with. I had a bout of regular, 10 minute apart contractions for 5+ hours on Friday night, the 27th , but it fizzled out to nothing by Saturday morning.

On April 29th, 7 days past my due date, Barbara came to my house for a pre-natal. We talked about doing things to work on getting the baby out, but nothing drastic. Baby was posterior at this point, and I was concerned about starting things before he or she was in a good position. I really didn’t want to be too aggressive. It suddenly dawned on us that we have an acupuncturist in our office! I had no problem having some acupuncture done at all. We called Evelyn and set up an appointment for the next morning and if things didn’t start, we would do it again in the late afternoon. That night, Darren and I went to dinner with Barbara and Sarah at Fleming’s. It was a wonderful evening, great food and great company. We had such a good time, joking with our server about my water breaking there in the restaurant.

We went to bed around 11:30 Sunday night, and like 6 out of 8 of my previous labors, I woke up to contractions in the middle of the night, at 2:16am. These were of a different quality than the ones on Friday night, but I didn’t want to get too excited. They were anywhere from 8-15 minutes apart, some lasting 1 minute or more, some only a few seconds. I was able to ignore them for the most part, and slept off and on until about 7:30am. I got up, ate breakfast, told Darren it might be the start of something, then called Barbara and cancelled my appointment with Evelyn. I puttered around the house, Darren filled the AquaDoula, and most of the kids stayed home from school. (They were all given the choice of staying or going to school. Talyn was the only one who chose to go.)

During this time, beginning at around 2am, one of our cats became my guardian. When I woke up in the middle of the night, he was sleeping on my pillow. He was by my side the entire labor, while I was at home. He followed me from room to room. When I went into the bathroom, he sat outside the door, meowing and stretching his paw under the door. He did not want to let me out of his sight.

Around 11am or so, things slowed down a lot. I figured it probably had to do with baby still being posterior. I was doing a lot of hands and knees and kneeling forward on pillows, my bed and my ball during this time, trying to encourage the baby to turn. I wasn’t worried, I just figured he or she would turn eventually. I had no back pain at all, which I was very happy for. I tried to keep busy, and organized all of my yarn, which I had saved for a labor project. It did keep me busy!

Around 2 or 3pm, it seemed as though everything came to a complete stop. I decided I needed to get out of the house. I don’t remember if it was hot or cold outside, but I remember telling Darren I wanted to go walk around at an indoor mall. The closest one to us is about 30 minutes away by freeway, and we were getting into rush hour. We were a little unsure about driving in it, especially if contractions picked up while we were out. We definitely did not want to get stuck in traffic. We decided to go to an outdoor mall much closer to home.

We got to the mall, and walked around a bit. Within about 30 minutes, I started having contractions again, and they were more intense than before, although still about 15 minutes apart. We went into a few stores, then sat down on a bench. Contractions had started getting a little more regular, closer and more intense, but still manageable. I was still able to walk and talk through them. We decided to go to dinner and then go home.

While we were eating dinner, contractions got a lot more intense. At one point, I had one that was so strong, I shoved the table away from me and into Darren’s stomach! We left shortly after that, and got home around 6 or 6:30pm.

Contractions continued, and I spent a lot of time in my bedroom. I was still kneeling forward a lot, trying to get baby to turn anterior. Darren asked me several times if I wanted to get into the pool, but I had checked myself, and knew I was only about 3cm. I didn’t want to get into the pool and have everything slow down. I continued laboring in my room, walking around the house for a few more hours.

This labor felt different than my others, and I can only assume it was because of the baby’s position. I never had any back pain, or really any pain at all. It just felt different, intense. I would check my cervix, and I could tell the head was not anterior. I found out by accident that standing up actually felt very good during a contraction! I decided to finally get into the pool, I think it was right at 10pm. I called Barbara right before that, maybe 10 minutes, and told her it would be a good time to come and do pictures. I really felt that I still had hours to go, and that I would probably have the baby by the morning.

Once I got into the pool, the intensity reduced by a tremendous amount. A few minutes after I got in the pool, I checked myself again and I was about 5cm. Darren was in the pool, and I would lean on him during a contraction. It was really good, and felt so much better than being on land. Things were picking up, and Darren said a few times that my labors always moved fast once I got into the water. It usually did, but I wasn’t thinking about previous labors at that point. Barbara arrived, set up some stuff and started taking pictures. I STILL thought it would be hours before the baby came.

Within minutes of Barbara’s arrival, my water broke (10:20pm). At that time, I am sure the baby turned anterior. Suddenly, things felt different, better! I checked myself, and I felt like I was almost completely dilated, with just a bit of a lip in front. I thought, “That can’t be right! I was just about 5cm a few minutes ago.”

With the next contraction, my body pushed. I was taken by surprise. For some reason, I didn’t feel ready to push. I said a few times “My body’s pushing, I’m not doing it.” I still felt a cervical lip, but it was shrinking with each contraction/push. Somewhere, a part of me worried about it being the cord and not a lip, and I asked Barb if she wanted to check it. She said no, that I was fine.

The baby’s head was really low, but I didn’t realize how close to birth it was. My brain had not caught up with my body, and I wasn’t in the place of mentally being ready to birth this baby. It went faster than I thought it would. With the next contraction, the baby was almost crowning, but not quite. One more contraction, and the head started coming, and I realized that this was it and I would be holding our new baby very soon. This is usually my hardest point in labor, I am usually very scared and I tend to freak out. But this time I didn’t, and I am so proud of that fact. It was intense, but I only felt a little bit of burning. I kept my hand on the baby’s head, and slowly it crowned, then was out. Well, mostly out. It actually came out slower than any other birth I have had. I had to push a little more to get the head all the way out.

There was a slight lull, then another contraction came. I pushed, but the baby didn’t budge. I felt the head, and thought it rotated, but it actually hadn’t. I tried changing position, and lunging my leg to the side, and still baby wasn’t coming. I knew it was a shoulder dystocia. I said something to Barbara, although I don’t remember what I said exactly, but I think I told her I needed help.

She told me to stand up and put my leg on the side of the pool, so I did. She asked if she could reach in, and I said yes. At this point, we knew the baby’s head hadn’t rotated. Barbara tried to get the baby out, but it was not budging in the least. She told me to get out of the tub, and get on the floor. I knew from another shoulder dystocia birth what she wanted me to do, so I got on the floor, and pulled my legs back into McRobert’s position. I started freaking out a little bit then, and it hurt like hell. The assistant, and friend of mine, D., arrived right as the baby’s head came out. Now she was on my left side, holding my leg back, but I was fighting against her. Barbara got the shoulders out, then the rest of the body, and she put the baby on my stomach.

As the baby came out, we heard a little sound, and thought everything was okay. But once he/she was on my chest, there was no response. I was rubbing, and trying to stimulate him/her, but there was nothing. Barbara asked for oxygen, and told me she was going to use it. I said okay. But when I saw her put the mask on my baby’s face, I thought it was over and that the baby was going to die. I almost lost it, I was never so scared in any of my other births. 10 puffs of oxygen in 15 seconds, and finally baby started breathing. The relief I felt was incredible, overwhelming. I found out later that there was also had a nuchal cord, and it was very tight. The cord was white and limp by the time the baby was born.

I stayed there for a few minutes, and then I needed to get up. I wasn’t very comfortable, and I needed to be able to get a good look at my baby. I wasn’t bleeding more than normal, which was a good thing. I asked Barbara if I tore, and she just said she didn’t know. I didn’t think I did, but with a shoulder dystocia like that, I would not have been surprised.

I got onto the couch, and after a little while, I started feeling lots of cramps. Some were horrendous. I knew the placenta had to come out, and I tried pushing a few times, but it hadn’t completely separated yet. I also knew from previous experience that it was starting to separate, and that the pain would stop once it was out. I was really uncomfortable, and I had to hand the baby to Darren a few times to hold, because the pressure was just too much on my stomach.

Finally, I felt something give, and I was able to push/pull the placenta out. (Looking at my chart later, the placenta was delivered at 11:38pm) Barb brought a bowl over, and I put it in. There was a HUGE clot, almost the size of a liver. And this was one big placenta. We weighed it later, it was 2 pounds. It was really cool to completely deliver my placenta by myself. Kyra looked a bit bruised to me, so I asked Barbara about giving her a vitamin K shot, which I didn’t do with any of my other homeborn babies. I really felt it was appropriate this time. Barbara asked if I wanted to give it to her, but no…..I was the client this time, not the apprentice.

I don’t remember how long we waited, but I decided it was time to find out what kind of baby we had. I looked under the towel, and saw we had another girl! (In looking at my chart later, it was 16 minutes) Darren was right, he said it would be a girl. She had a ton of hair too, which is blonde. She started nursing after a short time, and didn’t need much instruction. We sat in the family room, next to the pool for a while, then we went to our bedroom. We weighed her, and I was shocked when she tipped the scale at 10lb 7oz. I never thought she would be THAT big. I did her newborn exam, including measuring her head, which was a good 15”. Also another surprise to me, so I had to take a picture of the measuring tape around her head. Her chest was 16”, and according to my back-up midwife, this would classify her as macrosomic. Eh, I don’t care much, because she is here and healthy.

I went to the bathroom, and was 99% sure that I had not torn. By the second time I went to the bathroom, I was 100% sure. Not even a skid mark. No more bleeding than is normal. I used a frozen pad, just because I had them. There was some normal swelling, and the cold pad really did feel good, even without any tearing.

So, this birth was not quite as romantic as Landen’s. Barbara apologized for having to step in and catch my baby. But I have no regrets, no unfulfilled wishes, no feelings of disappointment AT ALL. I have told her not to apologize anymore. Yes, we wanted to catch our baby, and have everything go smoothly and beautifully, without a hitch at all. But what we wanted much more than that was a live baby, and a live mother. And we got those. Barbara did EXACTLY what I had her there for. She was here as our lifeguard. Would Darren and I have gotten Kyra out eventually? Possibly, probably. But I feel much better knowing that I followed MY instinct, my “feeling”, my “knowing” while I was pregnant. I feel that I protected myself and my baby exactly the way I needed to. I am grateful that Barbara was there, that I could trust her to only do what was necessary, what I asked her to do. If you read Landen’s story, you will know that I did ask for her help in his birth, but she knew I didn’t need her to take over, and she didn’t even touch me. For Kyra’s birth, I needed her to take a more active role, and she did just that. Once we were both stable, maybe 5 minutes, Barbara again stepped back and just observed. Exactly what I needed. I do feel that Kyra’s birth went perfectly, and exactly as it was meant to.

One last tidbit, and then you can read the post script if you choose…..One of my back-up midwives practiced for a while in Guatemala, where they did not wear gloves to attend births. At a pre-natal appointment, she asked me if I ever caught a baby without gloves. No, I never have, I have actually only caught one baby. Barbara mentioned that in all these years, she has caught one baby without gloves. She had to pull down a woman’s pants because the baby was actually already born, but mom’s pants were still on, and there was no time for gloves. Well, Barbara had been taking pictures of me laboring, and when it came time to help get Kyra out, she had no time to put on gloves. Neither one of us realized it until days later.

****As a sort of postscript, there is another part of all this that I need to include. It may sound odd to some, but most will get it and understand what I am saying. There are times, lately related to the births I have been going to, when I “know” things. It is hard to explain….I don’t see visions, really, but I have a sense of knowing, and sometimes there is a bit of “seeing”. I can sometimes envision a scene, but it isn’t specific or clear, more like a feeling.

We had a birth in December, in which I was going to catch the baby. It was going to be my first catch. Neither mom nor dad had any desire to be the one to catch. Barbara asked me often if I was excited, nervous. I said I was excited, but that the birth wasn’t about me, or my first catch, it was about the mom and her baby. I really felt that something was going to happen at the birth and that someone else would catch the baby, and I assumed it would be Barbara. I also mentioned a few times that I couldn’t see this mom giving birth. Usually I can imagine what it would be like. But this time, I just couldn’t visualize a picture in my head. As it turned out, I didn’t catch this baby because we missed the birth completely. I believe that is why I couldn’t “see” this mom giving birth, because I wasn’t meant to be there.

Our next birth was in February. This mom always had her babies very, very fast. Barbara often felt that we wouldn’t make it to her birth, but I felt very confident that we would be there. I often “saw” myself on the floor, next to the mom on her left side, and she was laying on the floor. There had been no discussion about me catching, I think the plan was for mom and/or dad to catch, although I can’t remember specific conversations. As this birth turned out, I got there before Barbara, and mom had the baby only minutes after I walked in the door. It was my first catch, as mom wasn’t in a position to catch herself. And after baby was born, and things started to settle down a bit, there I was, sitting next to mom, on the floor, on her left side.

So, I give this background to explain this part. Way back in the beginning of my pregnancy, I had a feeling, a knowing, that “something” was going to happen. I felt it was important that Barbara be there. I didn’t know what was going to happen, but I was scared of whatever it was. I tried very hard during my pregnancy to be positive, to not give into fear, to visualize a perfect, peaceful birth, much like #8 had been. Darren was going to catch our baby, and everything would go smoothly. But always, there was this feeling. During my pregnancy, my iron levels were very low, and I almost missed out on a homebirth, and I though “Is this the “thing”?” So, when my labor started and stopped and baby was still posterior, I thought “Is this the “thing”?” Then, when I felt the cervical lip, a thought went through my head that it was the cord, and I though “Is this the “thing”?” And when she was stuck, and I had to get out of the tub, I thought “Oh, this MUST be the “thing”!” But then I saw her on my stomach, not breathing, not responding, and Barbara breathing for her with oxygen, I thought “Oh please, DON’T LET THIS BE THE “THING”!!!” And thank goodness, it wasn’t.

When I was pregnant with Landen, I really wanted a UC. I had Barbara there because I trusted that she would respect my wishes and sit on the other side of the room until/unless we needed her. And she did exactly that. This time, I just knew that Barbara HAD to be there. I am very glad that she was.

I do wish every woman could have the same kind of gentle, respectful birth attendant. Some women want much more hands on, some need and want more guidance, and some want something completely different. I am forever grateful that I have Barbara as my mentor, my midwife and my friend. I am learning how to be the kind of midwife I feel is every woman’s right.

A Birth Unfolds in Photos & Words

2007-08-15T01:48:00.000-07:00

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.

smile

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."

blink

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)

Garden Laboring

2007-06-25T22:54:00.000-07:00

Mom at 7+ centimeters, walking in the Meditation Garden at the hospital. She is working towards a VBAC, has had AROM, has a saline lock in place on her left wrist, is wearing a Telemetry Unit (see it on the lower right of the picture, hanging like a purse off her shoulder) that continuously monitors the baby via the external belts as if she were sitting in the bed and is enjoying the company of her family, her monitrice, her husband, her doctor and the sun, wind and sky.

They wanted to put her in a hospital gown when we first got there, but she had that cute black top on. I suggested a sarong, but she didn't have one. I carry two so's I can help with mal-positioned babies during labor, so offered her the Mickey one or the non-Mickey one; she chose the non-Mickey one. She looks so much better dressed like this than in a hospital gown, don't you think? All women should dress in tank tops and sarongs in labor. Let's make hospitals carry sarongs, eh?

The laboring mom and me, the Tie-Dyed Monitrice.

The laboring mom and Dr. Wonderful! He's actually hugging the mom - and hugged all of us several times. He isn't afraid of getting "too attached" to his patients, obviously. I honestly believe he is a midwife in obstetrician's clothing. I am so blessed to know this man!

Mom did have a successful VBAC - 10 hours after her AROM with about an hour of pushing. She was told she would never be able to push out any sized child, yet pushed out an Occiput Posterior baby without any bony damage to either herself or her baby. Imagine that! Don't you love when women prove OBs wrong?!

It's Time to Tell the Story

2007-01-20T17:19:00.000-08:00

(I have permission to share this story in its entirety. The language I use is my own and might not seem politically correct to you. It presents no discomfort or anxiety to any of the African-Americans or the Anglos in my close circle of the story.)

In September, I was the midwife at the birth of a 23-year old black woman and her 24-year old black husband, both of whom are veterans of the Gulf War. The labor was rather long and I was assisted by my apprentice (who is white) and my assistant (who is black) and the dad's mom was also there. The other person there was a Home Health Nurse (HHN), a white woman who was about 58 years old, that the mother had gotten to know during the pregnancy. When mom (I'll call her Mary) wanted to invite the HHN, we had a session of exploring why she wanted her there and Mary said she was a sort of surrogate mom and she really wanted to show her what a home birth was like. In the first part of the discussions, that was the true reason that had come out... that she'd seen hospital births, but the prospect of being able to see a homebirth was fascinating to her.

At the home visit, we let the HHN know that birth wasn't just walking in and the baby dropping out. She nodded her understanding, but she still looked at us with a glazed semi-smiling look on her face.

When Mary was in labor, the HHN was bored shitless. Originally bounding in at 3am, by 20 hours later, she wanted to go home and wasn't shy about letting us know with her body language. She had gone home at one point to sleep, but when things picked up, we called her back as she'd asked us to. (Oh, if we could only go back.)

During labor, we laughed a lot. Mom spent time in the tub, wandered around the apartment and we listened to a lot of different types of music. One of the most amusing and memorable parts of the earlier labor came when dad put Sade on the cd player. I learned the pronunciation of the artist was "Shar-day" and when I, who was extremely tired anyway, said I knew every word of that particular cd and loved "Shar-day" so much, it set off howls of laughter from the black folk in the apartment. My apprentice and I, baffled by the cackles, didn't understand until they explained the pronunciation was actually "Shah-day."

An entire separation of cultures began, lovingly and humorously, as, over and over, differences were pointed out or given friendly winks and any word that could be twisted around, was to cause gales of laughter. One of the funniest was when mom got out of the tub and I got some Shea Butter to rub all over her very dry skin. Almost in unison, the black folk in the room said, "You mean the 'Sharrrrrrr' butter?"

Interestingly, once labor got really tough, mom coped really well with my assistant, so she spent most of the time doing the support. Having done labor support with several different cultures, I have often seen the most welcome support come from someone of the same culture and/or language. I was not of this mother's culture and my assistant was.

Mary started pushing and she really didn't like it one bit. Loud, raucous and wiggling, mom fought ever contraction and we, her support team, stroked, loved, cajoled, teased, directed, ordered, laughed, barked, whispered, waited, sat quietly, and offered her whatever we could as the head showed itself with a palm-sized amount presenting at the vagina. Thank goodness, the heart tones were holding their own during this one hour plus experience, but we didn't know how much longer that was going to be the case.

Mary screamed over and over that she was done. She was not going to do it anymore, to just pull the baby out. No amount of explaining could convince her the baby wasn't coming without her help and finally she exhausted herself and her body stiffened, her eyes rolled back in her head and she began to faint. To the uninitiated on-looker, it would probably look like the beginnings of a seizure, and surely could have been, but she shuddered slightly and when we took her blood pressure immediately, it was absolutely normal, her pulse fine and she was merely unresponsive verbally.

The HHN had her fingers on her cell phone and had already dialed 9-1 and I looked at her and said, "Call 9-1-1" and she hit the last 1 of the number, stepped out and within 2 minutes, two police officers were in the room. A few minutes after that, EMS was there and mom was a little more responsive.

All vitals remained normal as I explained the situation to the paramedics. We could still see the same palm-sized amount of head when she had a contraction and the EMTs were delighted that they might get to see a homebirth. Everybody was very respectful with each other and as the mom said she did want to stay home and birth there, the EMTs asked if they could stay and watch. Mom said, "sure" and the guys hung out and cheered behind me. I had to stop them from hollering at her to push (maybe I shouldn't have!) and they remained excited to possibly see the baby born. I explained things quietly, so they knew what was going on and the discussion in-between contractions was quiet and respectful between the Captain and myself. At least one of the young guys hadn't ever seen a baby born before and a couple of them hadn't seen a homebirth. He was giddy with excitement.

Then Mary started screaming again and no amount of trying to calm her down was working. In front of the EMTs and the HHN, the screaming wasn't going to go over very long so the EMTs asked if she wanted to go to the hospital and she cried, "Yes!" When I asked her what the hospital was going to do, she cried, "They will take it out!" I tried to explain that she would still have to push and I don't think she heard me as she began a mantra of "No, no, no, no..." and the EMTs brought the gurney into the room that had been sitting in the living room waiting the whole time.

If none of these people had not been there, we would have put mom in the car and gone to the hospital by my office. Instead, she was taken to the hospital the ambulance took her to.

There's this thing with midwives and EMTs around here. When we did In-Services, we asked about going in the back of the "rigs" with our clients and some of the guys said they would never let us in and some said it depended on the situation, but they all said to never ask... that they would pick who got to go. So, even though I had made it distinctly clear in speech and actions that I was the Licensed Midwife and Mary's husband was right behind her the whole time, the EMT in charge pointed to and said to my assistant, "Do you want to go?"

In a 5-minute conversation that lasted 20 seconds with our eyes (and just our eyes), the assistant and I looked at each other and said:
She: May I go?
Me: It'll be a great learning opportunity.
She: Shouldn't you go?
Me: But they asked you.
She: But maybe if you asked to go.
Me: Then no one will be with her; they'll get mad and she'll be alone.
She: I want to go.
Me: Then go!
She: I'll go!

And off she goes in the ambulance with my client. Dad and grandma follow behind in the car. My apprentice and I, having 2 other women post-dates, have to put the birth kit back together exactly correctly, but it doesn't take more than a few minutes and then we dash to the hospital ourselves.

What I learned later is that in the ambulance, the EMTs were terrified Mary was going to deliver and kept asking the assistant to look under the sheet to see if the baby was there. Praying the baby would be there each time she looked, it wasn't and the assistant had to tell the guys it was fine, the baby wasn't there yet. Mom was screaming with contractions and it sounded like she was pushing, but the baby wasn't progressing past the same place as before.
When one EMT tried to take mom's BP during a contraction, the assistant suggested they might want to wait until a contraction was over. When he was able to do so, he merely obtained the systolic and the person writing on the chart said, "That's enough for me!" It was certainly an odd ride.

Getting to the hospital, they were taken to L&D and the EMTs pointed to the assistant and said, "She can tell you what happened," and gave vitals before leaving. My assistant explained the labor's beginning, rupture of membranes, vitals throughout labor and mom's decision not to continue pushing at home - hence the decision to transport to the hospital.

Instead of continuing in narrative form, I diverge into a more official capacity. Follow along if you will.

Below, you will find the letter I wrote as the official complaint sent to JCAHO (pronounced jay-coh) - the Joint Commission on Accreditation of Healthcare Organizations - an organization that hospitals voluntarily join because it looks so great on their records since JCAHO supposedly is an outside organization providing an objective view of a hospital's performance in a variety of areas. From JCAHO's website:

Joint Commission evaluates the quality and safety of care for nearly 15,000 health care organizations. To maintain and earn accreditation, organizations must have an extensive on-site review by a team of Joint Commission health care professionals, at least once every three years. The purpose of the review is to evaluate the organization's performance in areas that affect your care. Accreditation may then be awarded based on how well the organizations met Joint Commission standards.

Coincidentally, within 2 months after I wrote my letter, the hospital in question had their review. This gets confusing, so please follow the bouncing bureaucratic ball.

First, about The Letter.

I was implored (by the Powers That Be That Shall Remain Nameless) to keep as much emotion out of it as possible. I had to write about 10 versions before I got to this sterilized version. No words can explain the amount of anger I felt during the recovery with this mother and trying to help her while having no one hear any of us screaming for help. I chose to use the mother's first name in the letter (not here, the name used is not her real name - anything in italics has been changed, not to protect anyone, but just because at this point) because I felt it would make a much more personal impact... that she was a real person and not just some "patient," but a woman with a baby and a husband and a life. I chose each word very carefully. It took me about 3 weeks to complete the letter.

So, here is the sterilized version and I will continue below the letter after that.

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October 11, 2006

To All It May Concern:

I am writing to notify you of a serious breach of care in That Hospital on September 11, 2006 between the hours of 2:00pm and approximately 6:00pm. Because this is a long and convoluted story filled with emotion, I will attempt to bullet point where the neglect occurred with the hospital staff and try to curb the intense amount of anger and disgust I feel towards those that interacted with and were supposed to care for my client Mary Morris and her newborn baby. Having attended well over 500 births in hospitals around the United States and Germany, I am well aware of the standards of care for a maternity patient and a newborn. I have also attended births in eight other hospitals here in Our County so understand the standard of care for this county in particular. What I experienced at That Hospital was anything but the normal standard of care.

• During the birth, I was, apparently, being summoned by Dr. Colon (quite loudly and angrily according to my client and my assistant), yet I was forbidden from entering the labor and delivery suite. I identified myself to the nurse at the front desk twice as Mary Morris' Licensed Midwife and she summarily dismissed me saying, “No visitors. Sit over there,” and pointed to the waiting room. I was permitted to enter approximately twelve minutes postpartum and never saw Dr. Colon.

• Dr. Colon stood against the far wall with his arms crossed as the baby was being born forcing the nurse to do the delivery. No explanation was given for this behavior. While I did not witness this, my assistant, the baby’s father and grandmother did witness this happening.

• Dr. Colon approached the delivery bed after the birth of the baby to pull the placenta out, causing excruciating pain for Mary. She still, many weeks later, remembers the pain in detail.

• Dr. Colon, while raising the bed, stated that he was sure Mary tore (in her vagina), but upon inspection, stated surprisingly there wasn’t anything but a skidmark (a common term for a slight abrasion). He then stated that he was going to suture it anyway and sutured her perineum without any Lidocaine or medication of any kind. Mary did not have an epidural. He placed one stitch in the lower left inner vagina. While the records state it was a first degree tear, his words in the delivery room stated otherwise. In 24 years, I have never seen even one suture placed without anesthesia.

• Dr. Colon never introduced himself to Mary, never addressed Mary, never asked permission to touch her nor even congratulated her for the birth of her son. He merely pulled her placenta out, sutured her without medication and then threw the gloves in the garbage and walked out of the room.

• No vitals were ever done by your staff on Mary during the time I was in the room which was approximately 3.5 hours.

• No one on your staff checked Mary’s fundus or her blood loss during the time I was in the room.

• The baby never went to the warmer.

• The baby never received Erythromycin eye ointment despite the parent’s desire for it. The hospital never offered to place the ointment within the first two hours of the baby’s birth despite it being the law. The parents ultimately signed a release that I would give the ointment at home, which I did, but they had not been offered it within the legal time frame.

• The baby did not receive a Vitamin K shot despite the parent’s desire for it. The hospital never offered to give the injection despite it being the law to give it very shortly after the baby’s birth. The parents ultimately signed a release that I would give the injection at home, which I did, but they had not been offered it within the legal time frame.

• The baby had his temperature checked twice – once at birth (which I did not witness) and once again about three hours postpartum. This is not the correct standard of care for a newborn.

• The baby had his heart and lungs listened to twice – once at birth (which I did not witness) and once again about three hours postpartum. This is not the correct standard of care for a newborn.

• The baby did not have his identification band placed on his ankle. After obtaining Mary’s medical records, it states in the records, “parents refused placement” which is incorrect since no one ever tried or came near with a band. The mother is a Licensed Practical Nurse and absolutely knows the vast importance of security in a hospital, especially of a newborn baby and would never have refused such an important detail.

• The parents were not told the baby’s birth time and only learned it when they went to fill out the birth certificate four days later. We had to piece it together via cell phone logs and were two minutes off for those four days. No one considered it important enough to tell the family the baby’s birth time, something that is a normal course of events in a typical hospital birth.

• The baby was given one hat. When asked for another hat, we were refused and told another would be given on the postpartum floor.

• The baby was given one blanket and it was wet from the birth and the baby had also had a bowel movement at the birth (meconium), so the blanket was covered in that, too. When we asked for another blanket, that request was ignored. We cleaned the baby with a chux pad as best as we could and used the sheet Mary was wrapped in (bloody and wet from the birth) to keep the baby warm until we found a blanket in the isolette tucked under a chux pad. We’d searched the room for a towel, washcloth, sheet, gown – anything – and there was nothing. I’d used my skirt at one point, too, to keep the baby warm. Once we found the blanket, we used that until my apprentice and the grandmother went home and got the baby some clothes.

• The baby was weighed only after the parent’s requested it several times.

• Mary was never given a gown.

• Mary was given one pad to wear during the entire time in her bed. The only time she was offered another pad was when we were leaving and the nurse brought a postpartum pack in and set it down by the sink in the room, not helping Mary, who was in the bathroom, in any way.

• Mary was not offered a frozen pad as women typically are after a vaginal birth.

• Mary’s sheets were never changed. She never received a blanket change despite our asking for something that wasn’t bloody and wet.

• Mary and her husband wanted to leave the hospital with the lack of care they were receiving, but I explicitly told them I felt it was important to at least stay the night and make a decision in the morning. And then the next event occurred that ruined any chance of their consideration of staying in That Hospital.

• A woman who never identified herself entered the room yelling and proceeded to demand Mary’s chart from me. I identified myself and explained that HIPAA regulations forbade my being able to give the chart directly to her, but I was glad to share the information with the mother’s permission. She became increasingly agitated and her voice escalated and the father and grandmother all began yelling together. At a birth! My best guess was the woman was the Charge Nurse since she, at one point shouted, “I’m in charge here!” She had a Caribbean accent (the baby’s grandmother was from the Caribbean so recognized it easily). The woman stated she needed information from the chart and for me to give her the chart immediately and I once again said I could not and said I had the lab information and flow sheet of her prenatals I was glad to share with her and if the mother signed a records release I was glad to copy the chart for her. The mother shook her head no and the woman left the room very angry.

• As she left, Mary said she would crawl out of your hospital before being subjected to the lack of care she was receiving by staying in. I could no longer disagree with her decision to leave.

• A woman entered the room and said she was a neonatologist, but she never stated her name. She said she was there to examine the baby. The parents said they did not want an exam and that was when the doctor left the room and left the door completely open with the mother naked on the bed and the curtain open. Those in the hallway stood staring inside the room until we realized the doctor was not returning and my assistant went to close the door. At no time did the doctor state risks of leaving Against Medical Advice or any concerns she had regarding the baby’s birth as has occurred with other clients who have opted out of routine hospital procedures in any other hospital over the last 20+ years in my experience.

• When Mary went to the bathroom for the first time, no nurse accompanied her.

• No final vitals were done on either Mary or the baby before leaving the maternity floor. This is in direct conflict with standards of care in my experience.

• When we left the maternity floor to leave, no nurse checked to make sure Mary had the right baby – in fact, no acknowledgement was made whatsoever of her presence and that she was leaving the floor with a newborn baby. No nurse accompanied her from the room to the elevator, from the elevator to the ground floor or from the inside to the outside of the hospital. She left the hospital unattended completely. No nurse was there in case she was bleeding or felt faint.

• When the baby was put in the car seat in the car, no nurse checked to make sure the baby was put in the car seat correctly.

• When we arrived home fifteen minutes later, the Local City Police were blocking the family’s garage and said the hospital asked that they come and check on the baby’s health and well-being. We were quite surprised considering how little That Hospital seemed to care when we were IN the hospital. They asked for proof that I was a Licensed Midwife, which I showed them immediately and they quickly left. I am not sure why Dr. Colon, the Charge Nurse or any number of others at That Hospital did not ask me for my identification while we were still at the hospital instead of sending the police to hinder the safety of the mother and baby; I would have complied happily.

• Child Protective Services was called on the family and came to visit on day two postpartum as well as have a lengthy phone call with me regarding the Morris’ parenting style and choice to leave That Hospital Against Medical Advice. She also stated there were issues with meconium staining the hospital mentioned. No one at the hospital had mentioned the concerns the day before. Her quick assessment that That Hospital’s accusations were “unfounded” speaks volumes regarding the lengths That Hospital went to discredit a perfectly respectable young married couple.

As a Licensed Midwife in Our County, I understand circumstances might not always be the most comfortable for me when I have a transfer or a transport to a local hospital. However, never have I seen a client punished in the way Mary Morris was punished for wanting a homebirth. And she transferred without any complications! I shudder to think how she would have been treated had she come with a life-threatening complication. It is beyond comprehension how human beings can treat a birthing woman and a newborn baby with such disdain and cruelty. There is no excuse for this type of behavior in a hospital in any city in America. For God’s sake, I recently returned from working in a hospital in New Orleans and their care was so tender and so loving - Hurricane Katrina had changed their emotional lives so dramatically that those nurses and doctors have found renewed spirituality in their care-giving skills. Does That Hospital need a disaster to re-awaken to human kindness? I pray not.

I will continue to work diligently in my profession to maintain the utmost in integrity. If any doctor, nurse, board member or staff member has any questions, please do not hesitate to call and ask me to answer it for them.

My Name, Licensed Midwife, Certified Professional Midwife
Ph# My Number Email: My Email

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So, I know it sounds unbelievable. If I read it, I would blink and have a hard time believing it, too. My apprentice and the assistant for that birth will look at each other all these months later and still shake our heads wondering if what we saw was real. It was.

It was so real, the hospital staff had to lie about it all.

When JCAHO was in town, we discovered we had an ally in the hospital. That person (whom we will call The Mole) became our inside information about the JCAHO hearings going on and tried to help us get into the hearings so our side could be heard.

You see, this is the interesting part about the JCAHO hearings, they are public, but unannounced. Well, The Mole let us know when they were, but the segments where the public can speak is minimal and specifically scheduled - and UNscheduled - if that makes any sense at all. (It probably does in bureaucracy world.) So, the parents and I called the JCAHO and hospital people in charge of the hearings asking to speak and we were told, over and over, that the hearings were unscheduled for the public. At one point I asked if I just needed to come down and sit 24 hours a day because I would. It was then that, of course, the public hearings were completed, so it wouldn't be necessary to come at all.

So, JCAHO never heard our version of the story beyond what I wrote and what the family wrote and an extensive interview done by some government man who didn't understand birth one iota.

JCAHO did, however, get to hear the entire story from each of the players involved on the hospital's side. Weren't they lucky? seething even now

The doctor, the head nurse (yes she was the head nurse), the "nice nurse" (whom I will speak about later), the bitch nurse, the neonatologist and every bit player involved got to have a say. And did they ever have their say.

The nurses said the mom was so out of control and so crazy, they couldn't get near her to give her a gown or to take the baby to put him in the warmer. BLESSEDLY, we have pictures (thank the Universe for my apprentice taking pictures!!!) of mom serenely holding her baby and the "nice nurse" holding the baby at one point on the way to the baby scale - gee, 3.5 hours postpartum, the baby still had meconium where we couldn't wipe it off of him... wonder why that was. Anyway, the nurses said we were SO mean and SO snotty to them that THEY CRIED at the nurses station!!!!!!!!!!!!!!!! They could hardly wait until we left because we were so mean. They'd hardly met any group of people so horrible. blinking in utter disbelief

If they cried, and I hope they did, it was from the amazing realization of the cruelty to another human being that they inflicted - TWO human beings. I hope they are crying right this minute.

Mary and her husband came to the hospital with a camcorder. When Mary was in the bathroom before she was leaving, I was in there with her as was her husband. My apprentice and assistant were getting the baby dressed on the bed. The "nice nurse" came in, gave us a "going home pack" by setting it on the sink in the room... not giving it to us in the bathroom (where we could have used it since it had pads in it) - and she walked out without saying a word. I had to walk out to the sink to go get a pad for mom.

It was days before we realized the camcorder, which had been sitting at that sink, was gone. The "nice nurse" had surely been instructed to kindly remove it from the room lest there be evidence on it. I am sure she is crying the most. She tried to be nice, but it was obvious she was told to give only the most cursory of un-care and words to us.

How did this end with JCAHO?

The hospital received a brand new Gold Seal of Approval! None of the nurses, nor the doctor were disciplined for their horrific behavior, BUT, the one thing that was found was the doctor had not explained the risks and benefits of lidocaine to the mother before suturing her (he claimed she refused the lidocaine). The hospital was fined a delightfully hefty fine from what I hear, but other than that, my mom is left out of any anything.

- No one to listen to her side of the story that would be able to do anything to the doctors or nurses directly.

- No lawyer will take her case because she can't show permanent damage to her or the baby (apparently fear of sex and the excruciating pain of being sutured without pain meds isn't worthy of a lawsuit - not to mention utter neglect in a hospital) .

- No restitution for her bills, pain and suffering or therapy she has needed to work through this experience.

HOWEVER, a New Mole has come out of the hospital steering mom into a new direction that might lead to a better sounding board than JCAHO. We'll see if it works out.

So, dear readers, you who know me can understand why I was so traumatized in September when this birth occurred.

Although I couldn't say it in the letter, in the investigation, we did state that race and socioeconomic status had a very big part in Mary's care. It was apparent they thought she was a single black woman coming in with her sister, when, in fact, the woman who accompanied her in the ambulance, was my assistant (who happened to be black). My client was having a hard time keeping control initially, but my assistant was able to calm her periodically and once the mom realized she was going to have to push the baby out in the hospital without assistance, she began to push in earnest and the baby was born within a few contractions.

(This brings me to the interesting concept we espouse about babies coming out even without a mom's active pushing. Apparently, this mom fought so hard against the baby, she maintained a location of homeostasis as far as where the baby remained in the vagina. The uterus, during the entire 90 minute pushing/un-pushing production remained extremely active and we could see the baby's head presenting more at the entroitus, but the baby receded each time the contraction ended. The thought that something might be holding the baby up crossed our minds, except there were none of the tell-tale signs of decelerations that would occur with a short cord or a nuchal cord. The whole thing was so odd.)

Immediately upon arrival, a nurse said to mom, "We're not nice like those homebirth midwives. We're gonna get that baby out." This was the Bitch Nurse. She continued being snotty and curt with Mary and was rough with her body and then with the baby as he was born. My assistant has an amazing capacity for recollection and I am thrilled she was allowed into the ambulance so she could make meticulous notes of every single thing that unfolded while I couldn't be there.

The doctor did, indeed, stand in the corner of the room yelling about me, asking where I was, why wasn't I there, that he knew there really was no midwife, that I had just ABANDONED my client and what kind of midwife is that. The whole time, the nurse is asking him to come to the table because the birth is imminent and he stood in the corner of the room with his arms crossed, not budging, in his street clothes. The nurse "delivered" the baby and the doctor strode to mom, shoved the nurse aside, put gloves on, yanked the cord so hard mom screamed until she nearly fainted, pulled the cord out, shoved his fist so hard down on her abdomen she had tears streaming from her eyes and then raised the bed to look at her while commenting that he knew she tore. Surprised, he said she just had a skid mark, but he was going to stitch it anyway. He grabbed the suture, placed the stitch while my mom screamed to the heavens and then he took his gloves off, threw them on the floor and turned and walked out the door.

That entire time, I was in the lobby trying to get in and was not allowed in. The nurse placed a faux call to the room and turned back to me and said, "No visitors," and pointed to the waiting room and told me to sit down and wait. I called my assistant's cell phone, but she didn't answer. Brilliantly, my apprentice called the hospital and asked to be put through to the patient's room. My assistant answered and she told me the baby had just been born (this is the way we pieced together the incorrect time of birth until we saw the hospital birth certificate work sheet 4 days later) and that mom needed her, she had to go. This was right when the doctor walked up to the table to yank the cord out and the assault began. It's too bad we weren't on a cell phone to be able to tape it.

12 minutes after the answering of the phone call, dad came out and brought us into the room. I walked right past the doctor, but he didn't say a word to me; I didn't know he was her doctor or I would have said something. Nobody ever asked me who I was, but I introduced myself each time a nurse came in, even the screaming nurse. Incredibly, I remained professional and civil (perhaps I should have gone berserk and run around the hospital floor screaming my disgust at their behavior? they would have kicked me out, surely.) and was very proud of my behavior with the staff.

I believe I would have been more demanding of "things" next time. Even though we asked for things like towels and gowns and washcloths and blankets and were turned down each time, something in me thinks I could have been more aggressive. I look at myself and wonder what I could have done to not have my client be punished in this way and in my heart of hearts know they were treating her this way because they just have an evil place in their heads for people of poverty.

When mom's husband came in during the delivery, he was shell-shocked, so didn't speak until after the birth and once he started speaking, the nurses started taking notice... the couple is extremely well-educated and don't "sound black" (according to how our society would consider blacks to sound). It threw the nurses off. And what was even more shocking to them was when, 3 hours into the horror, the insurance chick came in and snottily said, "I suppose you don't have insurance either, do you." Dad said, "As a matter of fact, we have Famous Great PPO Insurance," and the insurance chick about swallowed her tongue, threw the papers at them and rushed out of the room embarrassed as hell.

Having mom sign the papers to leave was our biggest mistake. Mom just wanted to get out of there and she didn't look at anything she was signing and signed too many things that ended up saying she didn't want this (Vitamin K) or that (Erythromycin). If you all are ever in a similar chaotic situation, do not EVER sign anything without reading it first - even if you can't wait to get OUT of there. It isn't worth it in the end. And, for the record, it isn't any of those papers that are keeping a lawyer from taking her case. The papers are the least of it in the grand scheme of it all legally, but because they are a legal document, in these investigations, they meant a lot. And it sucked to give them anything at all.

I am exhausted from writing this for 2 days and I know I could continue writing for 3 more because the 5 of us have picked this apart ad infinitum - we have considered and re-considered every nuance of this case. I have played and re-played every detail over and over, asking myself what I would have done differently.

You might wonder, what happened to the HHN? When the ambulance took mom out of the apartment, she left and didn't call for 5 days. She was "tired." The mom is very sorry she ever invited her to the birth and very much feels she had a hand in the demise of her homebirth, or at least, a peaceful birth in a location that would have treated her with respect and dignity.

Mom will have a homebirth next time. She says she will never be afraid of that pain of pushing again. She will find strength in that experience and not be afraid of most things in her life that are seemingly unbearable challenges. She has found enormous strength in her birth experience. Her husband loves her and while he was extremely sad to not have the homebirth he wanted so badly, he has supported and protected her in this healing in ways many men would never have known how to do. His words, his deeds, his tenderness and love ooze from his heart and cover his family in a way I don't see coming from most 40-year olds, much less someone of his young age. I am honored to know them both.

The assistant and apprentice have found healing easier than I (or so it seems to me) and they continue loving me through my pain. Is it always so different for the midwife herself? I want to erase the experience. I wish I could turn back time and find the magic words to make her push that baby out in her bedroom. I wish I never knew there were nurses and doctors who were so evil and cruel in my own city. I wish I still believed people could never be so evil to a birthing mother and a newborn baby. I wish I had never been witness to such horror. I feel like my illusion of hospital care has been raped... and my illusion wasn't even all that glamorous! I hate that I might have to go back to that hospital and have to find a way to work with a liaison to make the experience better.

Because those nurses can sit in front of the investigators and boo hoo and say this and that about us, but the absolute truth is - they know The Truth. They know who neglected whom, who assaulted whom, who stole what from whom. And I will stand with them, toe to toe, staring them in the eyes, also knowing The Truth.

I know The Truth.

And today, I finally speak The Truth for you all to hear.

December Birth # 3

2006-12-25T10:41:00.000-08:00

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.

December Birth #2 - Birth Brought Ailie

2006-12-21T17:42:00.000-08:00

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

2006-12-21T17:40:00.000-08:00

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?

and

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.

Connect the Dots

2006-09-27T17:47:00.000-07:00

(Times are estimates at the moment - charts aren't in front of me.)

1. Called to labor @ 6:30 am 9/26

2. Stopped by office to cancel appointments

3. Went to labor

4. Set up for birth on my own (not something I do often since I have the assistant and apprentice with me all the time - I liked it and moved slowly and meticulously)

5. Assistant and Apprentice Arrive about 9:00am (lots of morning traffic - they were 70 miles away)

6. Early labor - mom, dad and family interaction nice and fun

7. Teaching apprentice how not to open a methergine ampule, I slice my thumb, forefinger, middle finger, and hand from knuckle to mid-hand under wedding ring. It provides hours of amusement as I wrap and re-wrap the bandages several times because it continues bleeding; we consider going to the hospital for scrubbing in surgery to get glass shards removed, plastic surgery, placing sutures ourselves, decide on lidocaine ointment (which relieved the sting considerably) after scrubbing with gauze and Barney's Foaming Bubble Gum Soap. Apprentice and Assistant humor my whiny self by starting a chart and asking my hand's progress notes every 10 minutes or so if I don't volunteer it. They rarely have to ask since I am sharing every 2.5 minutes or so. They found some pretty purple bandaids to match my shirt for three of the slices and we hand the major slice wrapped like a fighter until nearer the birth, then I put a regular blue bandaid on it. The Princess one fell off. It was my left hand.

8. Without details, long labor with decision to move to the hospital. 2am-ish 9/27/06

9. JUST as the quiet decision to offer choice to family was being made, the phone rang and my other client that was due was in active labor. Her last labor was a 6 hour home birth of a 10 pound baby.

10. I had 20 min. to decide who was going to go where, gather up the birth supplies and drive the 40 miles to the next house if I was the one going.

11. 4 different midwives could not help... one on vacation, one whose dad was very ill in ICU, one with three moms at term or post-dates and one who was absolutely wiped out from various things with a mom hanging out there. I had no decision but to go to the mom in cranking labor and send my apprentice with the mom who was now heading to the hospital. I took the assistant with me. Neither of us had slept for about 18 hours. I hadn't brought my meds (like a goof). 2 doses down now.

12. Apprentice goes to the hospital with Client #1. I'm horrified that I have to leave Client #1 after all the work we've done during the pregnancy with abandonment issues. I work hard to get my shit together to be present for the next birth knowing Client #1 is in excellent hands with my apprentice while heaving with horrid guilt for leaving her. I feel I set myself up for this abandonment during the pregnancy by telling her I would never leave her. I note I can NEVER tell a woman that EVER again. How could I have known? How could I have known.

13. Assistant and I drive to Client #2

14. Client #2 had vaginal exam that took her from 1cm to 5cm (cervical adhesions broken... history of cervical surgery) and quickly went to 9cm.

15. Things slowed and I napped with assistant did FHTs every hour. When I woke after 3 hours and could barely remember my initials, I called and begged my favorite midwife to come and help me finish the birth. I was in tears I was so tired. She'd said no at 2am. At 7:30am, she said she was on her way. By 10am, she was there.

16. I stayed back and allowed the assistant do almost everything. I called Client #2 by Client #1's name at least 2-4 times. Hugely embarassed, I just shut up eventually after apologizing. I needed to get out of there. I took dad aside downstairs when the other midwife was close and explained that I was medically not safe, that if anything needed a sane decision, I wasn't going to be the one to make it. He expressed understanding and thanks.

17. New well-slept midwife comes

18. I retreat to the chenille-covered slider rocker and sob in the baby's room. I feel like a total failure. It is now 3 doses of meds I have missed. And a whole lotta sleep. I lay back and try to sleep and call my partner instead who begs me to come home.

19. I am worried about my apprentice at the hospital with no car and no sleep and work to figure out a way to get her home. She and I talk off and on. Client #1 still has not delivered.

20. Client #2 seems to have stalled somehow and I can no longer wait and cry. I have to find a way to drive 90 miles home and get into bed. I know I have to pass the other hospital on the way home. Will I stop?

21. Client #1 had been 9cm at home... then many, many hours later, was 7cm. At the hospital, was 9cm and then 7cm twice more. Something very, very odd had been happening. A cesarean seemed very likely despite this being a second child and a previous vaginal birth.

22. On my way home, I sob and shove exquisitely expensive Venezuelan chocolate into my mouth trying to figure out what to do. Stop? Will I be any good? I swerve over the bumpy dots on the road and float dream-like through the miles, seeing floaty weird ghosts out of the corners of my eyes thinking, "Hmmm... perhaps the new baby doesn't need to see these apparitions today."

23. I feel like a failure. Three September clients and all three I have labored with for HOURS and I will have not seen a one of the babies born. Do I scare the babies? I feel so horrible. I just cry and cry as I fly at 90 mph past the exit where my client is birthing (unbeknownst to me).

24. I get a message that Client #1 has delivered - vaginally - after 31 hours - a 10 pound baby girl over an intact perineum with a torrential hemorrhage postpartum. Thank god she was in the hospital.

25. I make it home and nearly fall over in an orgasm scrubbing my scalp and skin with a brush, soap and scalding water... I took two showers in one... one right after the other. I wanted to lie down in there and sleep.

26. I get out and find a message that Client #2 is being transfered to the hospital (!!!!!!!!!!!!!!!)

27. I cannot sleep. Instead, I take my meds and cry.

28. I eat some pasta and cookies and cream ice cream and feel better.

29. I get a call saying Client #2 is being wheeled into surgery. I am absolutely stunned. It's 3:00pm.

30. I finally go to sleep for a couple of hours.

31. I awaken to find that Client #1 is doing amazingly and is doing very well considering it all. We will have a lot of work to process, but she is so strong and powerful, we will do great. Baby #1 was born at 12:00 noon on the dot 9/27/06.

32. I talk to Client #2 and she is so thrilled with her daughter. 9#11oz baby that was coming out ear first (best as they can tell so far) She's now how a homebirth and a cesarean. Wow. Her baby was born at about 4:00pm 9/27/06.

33. I've cried a lot. Stood in front of several clients with no make-up, my hair a gross mess, no bra, clothes icky - and have been honest and tried to stand with no shame. I hated standing there so naked and raw. It was very painful. I forced myself to suffer through it.

34. Two healthy mothers. Two beautiful big girls. One humble midwife who doesn't know what her lessons are that she keeps not actually midwifing anyone but herself.

Could that be it?

Were you able to see the completed picture?

I'm not sure if I know what it all is yet. I'll tell you when I do. Probably after a night or two of sleep. And some regularly scheduled meds.

Baby in the Breeze - a wonderful HBAC story

2006-07-14T14:24:00.000-07:00

Sobbing with joy, mom kept saying over and over, “I did it! I did it! I did it!” Every one of us present cried right along with her – so beautiful, so amazing. She clung to her newborn son and dad danced around and she was so filled with disbelief, it was such a privilege to witness.

Through an odd series of circumstances, I became the overseeing midwife for the apprentice I worked with on that last birth before the New Orleans trip. Her mentor midwife was unable to attend this birth, so I agreed to oversee the apprentice as she was the primary – I was to assist.

Wanting a VBAC, mom was diagnosed with Gestational Diabetes earlier in the pregnancy and was on insulin for a few weeks, but then diet and exercise took care of the issue and she remained compliant and healthy the rest of the pregnancy. Because of the diagnosis, she was risked out of midwifery care and into the High Risk category with a perinatologist we sometimes like and who sometimes annoys us. The doctor agreed to allow a VBAC attempt as long as she didn’t go post-dates. He actually said he would do a cesarean at 40 weeks and was adamant about it. Mom was just as adamant she was not going to have a repeat cesarean without a serious reason.

Her last birth found her in labor for 48 hours and she never dilated past seven centimeters. She had been induced (I don’t remember the reason) and the baby remained in a very acynclitic position for many hours. Her cesarean was so pain-filled she couldn’t get out of bed for 48 hours and barely walked for three weeks. She vowed to never do that again.

After that birth, she read voraciously and vowed to do better the next time. When she got pregnant, her self-education increased tremendously and she practically memorized Ina May Gaskin’s Guide to Childbirth.

When time began pressing down on mom and the antenatal testing nurses got snippier and snippier about her “dragging this (pregnancy) out,” she turned to her doula trainer for help in finding a midwife to monitrice her. (A monitrice is a midwife at home, a doula in the hospital and a midwife at home again.) As a doula, mom had attended sixteen births, so knew some about birth from the inside, too.

The doctor, too, began his sales pitch about scheduling a cesarean, but mom deflected the talk by speaking of statistics and her informed desire to have a VBAC. He said he’d “let” her go to 40 weeks, no longer, but he really wanted to do a cesarean at 38 weeks.

With minimal time considering having a monitrice, she instead decided a homebirth would be her best chance at a VBAC. She was 38 weeks pregnant.

Once she passed 40 weeks, the heat was really turned up and she dug her heels in even more. She said she knew this baby would pick his or her birthday and she was going to wait it out.

She went for a BPP every three days and each one, the baby was great, so she was “allowed” to leave, only to return in another three days. She’d gone to her prenatal appointments each week, too, but decided to forego the one from a few days ago because the one before made her want to run crying from their office. The doctor called all the next day and she ignored the phone.

We did a prenatal at 41.2 and talked about all the options. The baby was extremely high, we could feel him/her above the pelvic brim and it alarmed the apprentice and me enough that we talked about it for awhile after the visit. Was this baby that big? Her first had been some over six pounds, could this be four pounds bigger?

She went for a prenatal in the other midwife’s office at 41.4 and the baby remained high. She declined a vaginal exam.

Once again, doing vaginal exams came up for me/us as it seemed apparent doing one was warranted to get an idea of what might be (or not be) happening. Not wanting to rush mom, we didn’t say anything for a couple more days and returned to her house at 41.5. Long discussions about outside limits for each of us ensued, the consensus being 42 weeks – or longer if the BPPs continued being normal. The only wrench in the mix was that the perinatologist was terminating care at 42 weeks and she would no longer be able to get her every-three-day BPPs. We talked about what options there were, including our doing modified NSTs, a 3H enema, stripping her membranes and even just going in and having another cesarean.

To get a better idea of what we were looking at, it seemed important to do a vaginal exam first.

Mom has a history that makes vaginal exams very uncomfortable, so the apprentice checked first and wasn’t entirely sure, so I checked afterwards. We were careful to be respectful of her limits and always asked permission first and listened when she needed us to stop or slow down. She did great throughout. Mom told us not to tell her the dilation because that was the most discouraging part of her last labor.

The baby was -4/-5, 40% effaced, not even one centimeter dilated and extremely posterior. Oh, my. Was that baby too big to find its way into her pelvis?

We went over dates again (for the umpteenth time) and mom was sure, sure, sure. 41.5 she was. I told the apprentice later the cervix felt like a 38 week one, not a 42 week cervix. She agreed.

The plan was to return the next day – 41.6 – and either strip her membranes and/or do the 3H enema. It all depended on how happy her cervix was the next day – and how high the baby was. Why was the baby so darned high up there?

Mom was very concerned about stressing the baby with the enema or stripping… her induction last time led to the cascade of issues resulting in the cesarean. We explained that if the baby was stressed by them, then the baby surely would be stressed by any moderate contractions and it was best to know sooner than later.

We gently told mom she’d have a baby by this weekend. She knew that meant “one way or another.”

We gave explicit instructions to lie on her side if her water broke until we got there (both the apprentice and I live within ten minutes of mom’s house) to listen to the baby. Because the baby was so very high, we were concerned about a cord prolapse. Mom understood.

After the visit, the apprentice and I went to dinner and spent three hours discussing every nuance of the possibilities before us. From the beginning, we had an odd feeling this birth would not end in a homebirth. We felt the baby was large and its being so very high seemed to confirm our concerns.

A comment by the apprentice proved prophetic. She said that sometimes this being a midwife thing seemed to imply we knew everything – could foresee what was to come. How could we know? Isn’t birth miraculously surprising? Couldn’t the baby and mom make some incredible changes in 24 hours? We explored this feeling and I shared that it isn’t that we know it all, but that we have a lot of experience and we are being asked to share that knowledge and experience. Yes, birth absolutely can surprise us – and will – but that it seemed unlikely this mom was going to have a homebirth, much less a VBAC. We remembered that we didn’t really see her having a homebirth from the first time we met her. (Of course we allow women’s experiences to unfold, but predictions, with most people, tend to happen. A hunch? Premonition? Prediction? Projection? Some things that are good for us to explore.)

We went to bed dreading the next day’s news to mom.

The apprentice was called at 2:00am – contractions had begun in earnest, but mom didn’t need us there yet.

At 2:45am, mom’s membranes ruptured. She called and got onto her side as we threw our clothes on and headed over.

I got there first, but not by much. Going in, mom was moaning delightfully, lying on her side and I grabbed my doppler and listened to a baby whose heartbeat was clicking along beautifully.

The apprentice got there, the doula (also a student midwife) soon behind her. My apprentice’s phone was busy and she didn’t answer her cell phone. She didn’t get there until mom was pushing.

Laboring happily, and I do mean happily, mom moaned and rocked, needing her husband’s love and touch more than anyone else’s.

When the apprentice and I had a moment alone, we looked at each other and agreed that something had shifted... it now felt like she could have this baby at home - and vaginally. Niggling worries still remained, but at least there was more hope than the day before.

Very quickly, we understood this birth wouldn’t be like most. Mom had to have dad’s hand/fingers on her clitoris. Over and over, she would nearly shout for him to touch her “clit.” Off and on, she would remind us that Ina May said how important orgasmic birthing can be – the midwife’s mantra quoted from Ina May Gaskin: What got the baby in there is going to get the baby out. At one point, mom said, “No shame” and we laughingly (and lovingly) said she was welcome to do whatever she wanted and needed to do to get her baby out. If his hand wasn’t on her vulva, her own was. Good for her!

She wanted more intensity on her clitoris at one point and asked if anyone had a waterproof vibrator. She was absolutely serious. None of us did. She later told us we needed to put that on the list of supplies required for birthing at home. What a great idea! She then asked a couple of times if we had something she could clip to her clitoris… a clothes pin? Blinking, all of us were so surprised and couldn’t think of anything to use. Mom would sigh and say, “Never mind,” and command her husband to put more pressure on her clitoris. “More!”

One of the times we left her and her husband alone to cuddle, the apprentice and doula went out to listen to heart tones. Dad was nuzzling mom’s nipple. When he stopped, the mom asked what he was doing. He pointed out the apprentice was there and she said something like, “You’re going to let two women watching hinder your sucking on my breast?” and he said, “I guess not,” and continued suckling while they gently listened to the baby and excused themselves quickly.

The first part of labor, dad was filling the AquaDoula and mom could not wait to get into the tub. Activity around mom – our setting up, dad and the pool, her son getting ready to leave with grandma – frustrated her, so we all slowed down, sent her husband to be with her while we took over the tub filling. She was much happier.

Mom wanted to birth outside. Living in a standard neighborhood, she wasn’t concerned at all about the birth songs she was sure to emit. She wanted some physical privacy, so dad made a grotto next to where the birth pool would be set up. Plants and a fountain were surrounded by bamboo shades and the entire area felt so peaceful and was really quite lovely. Purposeful beauty. We all smiled.

During labor, besides her vulva’s needs, mom insisted on being jammed in the lower back. During her first birth, she’d been pressed so hard by her husband – at her request – she was bruised and unable to be touched there for several days postpartum. We could see the same was going to happen this time. Alternately, she wanted hot packs, but also needed those pressed deeply in. The doula had some packs that got hot quickly with a zip and she used those for awhile, too. What seemed so hot to the rest of us brought sighs of pleasure to mom.

A few times, we heard mom starting to push, but after a couple of hours of not much progress, it seemed important to see what was going on. The apprentice did the first vaginal exam of labor and mom was seven centimeters and about 80% effaced. The baby was also at a zero station!!! (That baby moved down!! Shocked the hell out of us, you know.) Mom understood not to push really hard (remember, she’s a doula herself), so stopped the pushing, even at the peak of contractions. This place in labor was challenging for mom since she’d stalled at 7cm last time. She didn’t get frantic or upset as some women do, but kept going, determined to push this baby out her vagina.

A couple more hours later, mom really was struggling to not push, so we encouraged her to push when she needed to. Worried about pushing too soon, the apprentice did another exam and felt a cervical lip. Mom was elated! I asked if there was any molding and the apprentice wasn’t sure. She asked me to do another exam to make sure she was feeling the right thing and my exam found mom complete and a great deal of caput – which was probably causing the earlier pushing. The caput was a +2, but the head still at a zero station.

Before doing this latest exam, mom also asked to be catheterized because she could not pee. She could eek out a little bit during contractions, but it just wouldn’t leave her bladder. Climbing out of the tub, she laid down on the futon covered with yoga-like mats and a sleeping bag. The apprentice had seen catheters placed many times, but had never done one herself, but was exactly perfect in her placement and we removed about a cup and a half of urine. She ah’d and ah’d and ah’d about the relief and wanted to keep the catheter in there, it felt so good. Laughingly, we explained it can’t be left in and she sighed her okay as it was removed gently. Later, mom tells us the catheter being in was orgasmic. Not nearly orgasmic, but really felt orgasm-like in the relief it offered. She said she didn’t know why we gave her warning that it might not be a pleasant experience – “Don’t tell women that!” She had so much to teach us!

Pushing began in earnest. There is no way to tell you the utter joy mom felt in pushing. She literally glowed and smiled and hollered, “This is so great!!!!” throughout the 2+ hours of her second stage. She pushed and grunted and knew exactly what to do – her body leading the way. Side to side, knees to butt, mom moved all over the AquaDoula, instinctively knowing what movements to do to get her baby born.

Right at two hours, the baby’s heart rate, which had been perfectly normal throughout, zoomed up to the brink of 200 beats per minute (normal is 120-160). Alarmed, I asked mom to get out of the tub, that it was time to have a baby. The apprentice, who was the primary midwife at this birth, looked at me confused and I asked her what the beats per minute count she’d gotten. She said “around 160” and I shook my head no and told her it was 190-200. Mom got out and onto the futon as I explained the baby was now telling us it was time to be born.

Mom is GBS positive (and didn’t want antibiotics unless warranted), so that was a concern, but she’d also been in the hot tub for several hours. Perhaps the baby was too hot? (The water wasn’t much higher than 98 degrees.) Mom’s temperature was 99.7. Yikes!

Once again, I told mom it was time to birth her baby. We could see the head (caput) coming and she was doing a great job pushing. I encouraged the apprentice to go in her vagina and press her ischial spines apart to help the baby come out sooner, giving some assistance. Heart tones were still above 180, but at least they were some down. The baby moved great with each deep push, slid back up in between. With the apprentice’s help, including putting her fingers at the bottom of mom’s vagina, the birthing woman was able to push more effectively. She continued putting pressure on her clitoris and cheered as she was bringing her baby out. Feeling how much of the head was out helped her enormously!

“I’m doing it!” she would say over and over and we were filled with joy that our predictions were being proven absolutely incorrect.

Two contractions before the baby’s head was born, mom rested on the futon, opened her eyes and looked at the sky. She said, “What a beautiful day to have a baby. Feel the breeze?” And we all closed our eyes and felt the wind blowing through their grotto, around the porch, through the trees and tinkling some faraway wind chime. It was a moment of peace during some quick-motion movements to help a baby be born.

The baby’s head was born, already somewhat diffused, and didn’t rotate. Mom stopped having contractions despite some nipple stimulation by dad and me, so she was encouraged to push the baby out anyway.

I encouraged the apprentice to assist the baby out. She pressed downward on the baby and there was minimal movement, but when she stopped, the baby slid back inside. I said, “Do it again,” and she repeated the movement, the baby sliding back in again. I got mom’s legs back and the apprentice said, “Switch places.” I said, “No, you can do it,” and put my hands over hers so she could feel how to assist a baby out that needed help. With not-so-hard traction, the baby finally slid out (2+ minutes after the head was born – no contraction at all) and flopped up onto mom’s belly with her help. (I’d call this sticky shoulders, not a dystocia.)

Elated, she kept saying, “I did it! I did it!” and I busied myself drying the baby and making sure he (a boy!) was going to breathe spontaneously. After a few moments, he opened his eyes, a little stunned at his arrival and grunted a hello that let us know he was going to be perfectly fine without any resuscitative efforts at all on our part, just stimulation with drying. Meconium spilled out behind the baby and lay on the chux under mom’s bottom, along with a goodly amount of blood.

My apprentice had arrived during the beginning phases of pushing and took over 200 pictures during the birth. Happily, it was outside and no flash was needed, so pictures were no intrusion whatsoever. Mom commanded us several times to take pictures and get the video on so she could get every part of labor and the birth. It was a joy to do so!

As soon as the baby was making more noise and his spirit firmly on the earth, mom started crying tears of joy. All of us were crying (except the apprentice still in working mode making sure mom wasn’t bleeding too much – I observed her from my tearful state) and it was such a beautiful, beautiful few minutes with salty tears and words of joy and praise lifting into the breeze that brushed against us in the mid-morning sun.

The placenta was born without problems, no undue bleeding or anything – the blood on the chux pre-placenta had come from some decent second degree tears deep in the vagina – we found out later.

After some cuddling and cleaning up, the cord was cut (after asking permission) and dad held his son as mom walked across the yard, up the stairs and across the house, then climbing up onto her bed – all the while squealing, “Do you see this?! I’m WALKING! It’s an hour postpartum and I am WALKING!” We saw and we applauded her.

The doula made scrambled eggs and bagels for everyone to eat while the apprentice did a great suturing job with my watching over her shoulder.

Southern California is in the middle of an oppressive heat wave. Air conditioners in the luckiest of homes run continually as this region simply isn’t used to such heat. The breeze outside did not translate to coolness inside; we were sweating our heads off. I put a fan directly on the apprentice suturing – suturing can be sweaty work even in frigid temperatures. One window air conditioner in the dining room found us girls jockeying for position in front of it, purposefully finding something we needed to do outside the incredibly hot bedroom.

I took the baby’s temperature and it was 99.7!! I yanked those blankets off the baby and removed the hat and he cooled off when I took his temperature 15 minutes later. It really was hot as Hades in there!

While he was naked, we weighed the baby.

9 pounds 4 ounces. Nearly three POUNDS bigger than her last child.

The doula set out making mom chocolate cake while we cleaned up things before mom wanted to get in the shower to get refreshed. While she was in there (my apprentice staying near in the bathroom, chatting with her), dad held his baby and the other apprentice and I got the top sheets and plastic that was pinned to the bed off of there and her new clean sheets ready for her return.

Once she was tucked into bed, dad quickly showered as mom held her baby to her breast – he nuzzled a few times, but was just beginning to seem interested in getting some colostrum.

Lots of jokes were made, started by mom, about her (said sarcastically) gestational diabetes and her giant post-mature baby. Once we really examined the placenta and showed mom how absolutely gorgeous it was, we knew there was no way… NO WAY… this baby was 41.6 weeks. There was one sand-grain-sized calcification and otherwise, it was a gorgeous, fully liver-colored placenta. No staining. The sac remained strong and didn’t shred as late membranes are wont to do. Confused, I mentioned the placenta looked like a 38 week one.

Mom could not wait to call the doctor who threatened her all those weeks.

Seeing this, I did a cursory newborn exam and declared the baby at about 38 week’s gestation. He lay on the bed with his arms and legs open like butterfly wings… flat on the bed. He had some, but not much cartilage in his ear pinna. His breast buds were not well developed, he had creases only ¾ of the way down the soles of his feet and his skin showing blue veins and a beautiful, creamy-textured pink softness.

Later, I remembered how I’d said her cervix the day before was more like a 38 week cervix, not a 42 week one. Suddenly, it all came into focus and mom said it sure might have been possible to have conceived two weeks later than she originally thought, but ultrasounds and all measurements pointed to the due date we all had been working under.

Had she been cut at 38 weeks when they first said they wanted to, that baby would have been 34 weeks gestation. Even at 40 weeks, the baby would have only gestated out to 36 weeks. Mom was so, so thankful she was adamant about waiting. She said, over and over, she knew the baby would pick his own birth date. She knew he would know and he wouldn’t die inside her waiting to be born. She was right.

When the cake was done and frosted, we all had hefty slices and sang Happy Birthday to the new birthday boy. More tears mixed with the sweet chocolate on our lips.

Mom was given her postpartum instructions (the apprentice had already done a more complete newborn exam) and we all stressed her need to relax. She wanted to get up and cook for everyone she felt so good! I laughingly told her, “You VBAC moms are the worst in trying to keep down! Y’all are so danged high; you think you can conquer the world!” Well, they can do that… just not clean it within the first two weeks of the birth!

Four hours postpartum, we’d packed the supplies, done two loads of laundry, cleaned the kitchen, made sure the porch was cleaned up, got the chairs put back where they belonged and readied ourselves to leave.

Kisses all around, thanks for the honor of attending, thanks for our being there, thanks for the glorious breezy birth – everyone so high with love and amazement – no one more than the apprentice and I who were brought to our knees in humility. Birth, many times predictable in its normalcy and ability to follow patterns, sometimes jumps right up there and shocks the hell out of us… making us eat our words.

Mighty tasty chocolate words they were, too. I am glad to have heaping servings of this time of humility any time.

When asked postpartum what had shifted, mom said she prayed the night before - allowing fear and the baby to be born all at the same time. She kept picturing them both pouring out of her body and she felt, for almost the first time, too, that she really was going to birth this baby vaginally and at home.

A baby born in the breeze.

Stepping outside in the pressing afternoon heat, I stopped as the wind picked up and blew across my face and arms and legs.

I, too, was re-born.

New Orleans VBAC Story

2006-06-27T14:29:00.000-07:00

I stumbled out to the back porch and sat in the upper-90 degree muggy heat, cell phone in hand. As I dialed the phone, hot tears began falling. My apprentice was at a birth, so I re-dialed one of the very experienced student-midwives – the assistant at the last birth. When she answered, I began telling her how we’d been in labor for so long, how she’d been pushing for so long, how the baby was doing fine, how tired I was – by this point, I was blubbering and she asked me to slow down, take a deep breath and try to speak more clearly because she couldn’t understand me. A flood of emotion streamed out of my mouth and I could barely contain my distress at how tired I was and how worried I was my client was going to go to the hospital and be cut. Once again, the midwife asked me to slow down because she couldn’t understand me through the tears.

I took several deep breaths and began at the beginning.

I was called to check on mom right after midnight, but sent mom to the bath and to bed and left to sleep again myself. I was awakened at 4:30am and once I got into the house at 4:45am, I could tell mom was finally in true and active labor. Vitals were great, the baby sounded wonderful and mom wandered and moaned with the regular contractions.

Her two-plus days of prodromal labor had taken its toll on everyone in the house. No one more than mom, of course. We let her husband sleep for as long as he was able to and called the doula to find her way over to the house when she was able to (she has kids she needed to get to a sitter). Come to find out she’d spent the night awake babysitting some drunk co-workers and hadn’t gotten any sleep at all.

Wandering, leaning, sipping water, mom puttered around, moaning lightly with the contractions that were 2-4 minutes apart and lasting almost 60 seconds. She’d been watching and timing contractions so one of the first things we did was to cover the clocks. It was almost a symbolic gesture in that she never once looked at them again or even asked what time it was. Around 9:30am, I reminded her to take a medication she needed and she thought she was very late taking it, thinking it was 4pm or so. When we told her what time it was, that was the last time mentioned for the rest of the day until the birth of the baby.

Dad woke up somewhere after dawn and then the girls got up and were sent to a neighbor’s house for the day. They had a great time, coloring for mom, reading – having fun that wasn’t labor watching.

My client’s mom was up from the first time I was called over. She, a trooper throughout, was supportive and reassuring – having 8 kids of her own.

An amusing sidelight: All three of us – laboring mom, her mother and I all share the same first name. The birthing mama and I also share the same middle name! And it isn’t something usual like “Ann,” either. It got confusing with all the same names in the house, so I was nicknamed my name with _wife on the end to designate me from the others. Funny!

When the doula came over, she was exhausted. She grabbed a Coke, sat in the glider in the bedroom where mom was laboring and promptly fell asleep. She looked much like a toddler in a car seat… you know, when they are all curled sideways, hunched over, looking so incredibly uncomfortable, but they never wake up? That’s what she looked like. Tired myself, I shooed her out of the room about an hour into her nap. She then curled up on the couch, pillows on her head and slept 2 more hours. I teased her about it all afterwards. She said she never would have done that in a hospital birthing woman, but felt like there wasn’t a lot to do. That feeling is expressed often by doulas attending homebirths, especially the first few times.

Mention needs to be made of the client’s dogs. She has a Bouvier that weighs 105 pounds and a Staffordshire Bull Terrier – both of which are her dearest friends and a great support to her when she is scared or worried. Her first labor, she hugged the Bouvier for hours and expected to do the same this time. During some of her prodromal labor, she did in fact hug her puppy, but they merely stayed close while she was in labor, sometimes on the bed, other times at the foot of the bed.

The Bull Terrier seemed to have eaten something horribly rotten the night before and was sharing the foulest farts in the history of farts. When the doula woke up, she was barely coherent and the dog farted and the doula nearly passed out from the stench. All of our eyes were burning and the doula really did turn sheet white and sway. I was worried she was going to fall into mom so had her move to the glider rocker where she put her head between her legs. The farts were disgustingly amusing. Mom doesn’t remember smelling them at all! Let’s here it for LaborLand!

At one point on the toilet, mom wasn’t sure if her water broke, so I got out the nitrazine paper and it turned dark blue. Ayup. Amniotic fluid there.

Labor continued for awhile and it got to a point where mom was pushing, but nothing was happening, so I asked if I might do an exam to see what was happening. The baby was doing fine, but didn’t seem to be budging. An exam showed she was 9 cm. Light pushes for a few more contractions and then the urge was overwhelming.

For a midwife who tries hard not to do vaginal exams, this birth had more than its share of them. Something wasn’t right and I couldn’t figure it out. Over a several hour period, mom went from 9 to complete and +2 to 8 and -1 to 9 to a lip… it was the strangest thing. Frustrated that position changes, talking, wonderful pushes and her water breaking again, this time with a humongous gush that soaked me enough to send me to change clothes didn’t show any progression towards birthing. Fluid was clear again, baby sounded great, but I had exhausted my mind and ideas. It was time to call someone.

During the labor, mom leaned on dad physically and emotionally. He was loving and kind and her mom was equally loving and supportive. As time went on, however, I could see their growing nervousness which turned to agitation and then to franticness regarding the situation. I tried to calm them as best as I could, but my main focus was mom and trying to figure out what was going on.

It’s interesting writing this because in the moment, all of this wasn’t entirely conscious. A lot of this is an undercurrent of care as a midwife. I don’t remember thinking: Why is the baby stuck? at all. It wasn’t until I called the midwife and she suggested perhaps there was a cord holding the baby up that I was able to put into words my frustration and concern.

I so wanted her to have a VBAC. While I try hard to allow each woman to have her own walk, I also do have dreams and wishes for their births – the same as they do for themselves. After my sobbing talk on the phone, I pulled myself together enough to talk to mom in the tub (she was trying not to push for an hour to see if that helped the cervix issues). As soon as I got in there, she said she can’t do another hour. The baby had moved into a position that dug her feet into mom’s ribs and she was in excruciating pain. Two other points of stabbing pain on either side of her spine made it difficult to concentrate on the contractions at hand (she tells me later). The decision was made to transfer to the hospital.

I wept some, apologizing and they said it was perfectly fine, not to worry at all.

During the times we spoke leading up to the birth and even in the hours before labor began, we’d assumed that any trip to the hospital would be for a cesarean. It was a given. Later, mom tells me she never even had one iota of a thought that she’d have a repeat cesarean as we talked about going in. She isn’t sure where that belief came from – and her husband shared it – that it seemed odd to have me sad that we were moving to the hospital. She knew surgery wasn’t in the cards.

Then we set about getting to the hospital. I called the doctor, but her doctor (who’d said she’d come in for the birth and asked that she’d just come in before crowning, please) wasn’t on-call, so I spoke with the doc on-call. She insisted on talking to mom and it was then I knew we were really heading in and would be there in about 15 minutes.

Besides the cervical flip-flopping and stopping pushing periodically for a few minutes, she’d been pushing for 5 hours by the time we left the house.

Looking back, it’s so interesting to me that I didn’t even have one iota of a concern regarding the length of time she was pushing. I didn’t worry for her uterus at all. I worried for her stamina and peace of mind, but health-wise, I knew she was strong and healthy and could do this; I never had any doubt.

During the 90 minutes or so before transferring to the hospital, I could see the tension mounting in the grandmother and husband. Imploring eyes became nervous agitation and by the time mom was in the tub trying not to push again, I could tell both relatives had reached their tolerance-for-a-homebirth limit.

I prepped mom with the happenings in the car and how fast things move in the hospital, pokes, BP, temp, questions and more questions. She nodded her understanding, got in the car and I followed in the doula’s amazingly trash-filled car. I brought the birth stuff in case she delivered on the way. One can wish, right?

At the hospital, we entered in the ER and admissions had too many questions for us to answer. Fumbling, we finally found mom’s paperwork, told them she was pre-registered and said, “She’s going to have this baby right here if we don’t hurry up!” The security guard grabbed a wheelchair and nearly shouted, “Not down here she isn’t!” and took off with mom, zipping faster than any wheelchair with a laboring mom has any business going. The service elevator wouldn’t come, so we took the regular ones – they took so long, all of us old and fat people caught up enough to get into the elevator at the same time.

In L&D, the nurse who weighed twice what I do told us to go into the room directly across from the nurse’s station. The one nurse and an LPN were the only people there. When they were in the room, no one was at the desk. We never saw another nurse at the desk the entire time, even when grandma, the doula and I sat in the hall waiting for the doctor to insert the epidural.

When she got into the room, my client was handed a gown and she said she didn’t want one. What was very interesting about the gown experience is that it was a large-sized gown! The large gowns were the norm and the smaller gowns were the exception. How clever! The nurse didn’t seem concerned about the gown issue except in the door and curtain remaining closed to protect my client’s privacy. There really wasn’t anyone ever in the hallway, so it seemed, moot, but we were respectful and complied anyway.

The nurse, Jill (not her real name), assessed my client’s contractions quickly and pulled out a sterile glove after I told her she’d already had rupture of membranes with clear fluid. We could tell she was giving all of us the once over, who are these people? and she firmly, but kindly explained to my client she couldn’t call the doctor until she examined her. She didn’t even want to hear the baby’s heart tones until she’d done an exam, so my client, naked to the world, hopped up on the bed and had yet another vaginal exam. She was 8 cm and -2. This was the craziest cervix I’d ever experienced!

What could make a cervix do this back and forth trick? When I was crying and talking to the other midwife, she reminded me that short cords do this sometimes and they needed some bungee time to stretch enough to allow the baby to be born. While I’d heard of such things, I have only seen it happen once or twice, but nothing this dramatically. To go from complete and +2 to 8 and -1… well, that was just so odd. And it is important to note that her cervix was not swelling, either. She was completely effaced – an aspect that never changed. It’s just that there was cervix there. And then there wasn’t. And then there it was again. I was baffled.

When the nurse heard my client was a VBAC, she said, “So you want to do this naturally, right?” and my client burst out, “NO! I want an epidural!” Confused for a moment, I heard, “You want a vaginal birth” whereas my client heard, “You don’t want medication.” Jill quickly said the anesthesiologist was already on the way in for another mom, so she’d have to get the IV going quickly so she’d have enough fluids on board for the timing of the epidural.

As Jill moved around the room, I could see her trying to figure all of us out, too. Doula, grandma, dad, midwife and mom – all encouraging mom and helping her get comfortable. I didn’t want to seem too know-it-all, but I also wanted her to know I had the clue bucket in my hand. Before 10 minutes was up, I casually made a comment that we were a room full of nurses and midwives – (grandma is an RN) – and Jill visibly thawed.

Suddenly, there was something for everyone to do.

Jill went for the vein in mom’s left hand, but it blew (bad) and she had to move to the right hand. Dad was holding the gauze on mom’s bleeding hand and I stepped over there to take over so he could be with her without having to do clinical things. The nurse got the vein in her right hand quickly and I handed her the IV tubing and started it running.

Sitting here writing, it sounds so silly to mention the things I did – like I am some big shot or something, but that isn’t how I mean it at all. What I am sharing it all for is the aspect of how needed each of us was… how we all worked as a team. There was never any turf war between us at all. At one point, Jill said her job was to stay out of our way as much as possible so mom could birth. Huh? Where did she come from and can we clone her?

Jill asked us to put the pressure sleeve on the bag of Lactated Ringers and grandma began doing so. I looked at this piece of equipment and felt like I was in a foreign land. I’d never seen such a thing! I’ve always had to mash the bag to get it to run wide open. Who invented such a cool device? (I am not sure of the technical name for this sleeve, either, forgive me if I am calling it the wrong name.) Grandma hung the bag by the sleeve instead of the LR and it began slipping out, so the very tall doula replaced the sleeve over the bag of fluids and we pumped the thing up as high as it would go. The pump-y thing was just like a blood pressure cuff pump… I knew what to do with that. Once the contraption was working correctly, a liter of fluid ran into my client in less than 10 minutes. Wow!

Before long, the anesthesiologist wandered in – in tennis whites with Nike tennis shoes – he looked 12 from afar! (He really was about 50 when we spoke with him later.) Happily, the doula, grandma and I stepped out so mom could have the epidural of her dreams. She’d been phenomenal and deserved to have some pain relief. Those three stabbing points were still excruciatingly attacking her; she could barely contain her joy at seeing the doctor. The nurse had gone out for the epidural tray, a far cry from the epidural cart I am used to. The doc never gowned (that I saw) and came out of the room not 8 minutes after he walked in, mom in complete comfort almost immediately. I asked if she’d had a spinal (because those usually take effect so much quicker and are easier to place), but the doctor said no, it was an epidural. This was confirmed by the nurse later, too, when I was really confused by the lack of a pump or thread or anything. Apparently, I am not so hip on regional anesthetics.

In the hallway, we three sat in wheelchairs and they were all the extra-wide wheelchairs. Large-sized gowns? Super-sized wheelchairs? Was I in the land of the Fat-as-Normal?

The doula told us she had to go to work and wasn’t sure how to tell mom. Should she just go? I shook my head and encouraged her to just say it outright. She said if she was doing a regular doula job, she would never leave her, but being in such good hands, she felt she should go to work.

As soon as we all re-joined a now-chatty mom, Jill said the doctor was right behind her outside the door. The doula explained that she needed to go to work and mom was fine with it, so we lost one part of the birthing team.

When mom said she felt intense pressure, the doctor came in and was all smiles.

During the pregnancy, mom had another female doctor who’d paid lip service to having a VBAC. As the pregnancy progressed, however, it became more and more apparent that she really didn’t believe in my client’s abilities to birth vaginally. At one particularly disturbing visit, my client was told she wouldn’t be able to birth a baby bigger than 6.5 pounds out her very small and odd-shaped pelvis. The last straw for desiring change came when mom said she wanted to have a tubal ligation after the baby was born and the doctor was crazy angry that she wouldn’t just have a cesarean so she could do both at once and “not waste time.”

Finding this new doctor, who’d had two cesareans herself, she learned she had an 80% VBAC rate. The first doc said she could do that too “if she was picky” with the patients she chose. The new doc, however, takes anyone desiring a VBAC and works her ass off to provide just that.

My client had two prenatal visits with the new doctor before seeing her in the LDR. One visit was a pelvic exam that had the OB blinking in confusion as she said mom had a “perfect gynecoid pelvis” and would be just fine delivering vaginally. At the second visit, the doc asked if she planned on staying home for a good part of her labor and my client hesitantly mentioned her friend the midwife coming to be a doula for her. The doctor didn’t bat an eye and asked if I’d be able to take heart tones during labor and was told yes, I would. She then laughingly asked if my client could please come in before crowning – it makes things much easier.

As the doctor walked in, I said to her, “You asked that we come in before crowning… well, here we are!” She was a delight, introduced herself all around and asked how mom was doing. “Great now,” was the answer. The OB grabbed a sterile glove and did a vaginal exam saying the baby was so low! That mom was complete (she felt around for a goodly amount of time, surely checking the baby’s position, too) and a +4. What!? I looked down and saw no sign of a head. + 4? The nurse’s eyes bugged out of her head and the doc said mom could keep pushing and she’d be back in a few minutes.

So, the bed was broken (down) and we began helping mom push with the contractions. As she pushed, the heart rate was fine and dandy. However, when she stopped pushing, the heart rate began dipping lower and lower. Oh, that stinking cord again! We flipped mom on one side then the other and then just said, “It’s time to get the baby out.” I went to the desk to get the OB and she came in, gowned and said, “Let’s have a baby!”

Pushing, pushing and more pushing didn’t bring that baby down, but did bring the heart rate down in-between pushes. At first, the heart rate was in the 80s in-between contractions, but then would climb to 100 – 120 during the contractions. The doctor looked up and said, “It’s probably a cord somewhere.” Aargh! I was never more sure of that than that moment!

Calmly, the doctor asked the nurse to go get the forceps. Huh? They aren’t on the delivery table? I looked at the delivery table and saw how sparse it was decorated. Minimal instruments – something I’d never seen before this moment – lay on the sterile table… no forceps, no vacuum under the table… one set of suturing instruments. Interesting.

As Jill was walking out the door, the OB was gowning and another nurse breathlessly walked in and said she (the doctor) was needed for a stat section. The OB said she couldn’t go and the nurse said, “But they need you!” Looking at my client and the monitor, she continued gowning and said, “You’ll have to find somebody else, this baby is important, too.” This was yet another sign of the lack of personnel the hospital was working with. One of many.

The LPN sat at one of those hospital tray thingies and charted the whole time. She never got up from her seat and never said a word, just charted everything as it unfolded. Picture her quietly sitting throughout the story.

Jill came in with the forceps and the doctor asked her to alert Peds that they would be needed for this birth. Jill left as the OB clanked the forceps together to scare the baby out (sometimes just the sight of them is enough to inspire moms to push harder and faster). When Jill returned, she said that Peds was in with the section and they would come in when they were finished. This was nurse-speak for “We’re alone here.”

The OB asked me to go turn the warmer on for the baby, so I did that quickly and returned to mom’s left side. Jill was on her right, dad at her head above me and I am not sure where grandma was. Down near the bottom?

My client was pushing with all she was worth, even with the epidural, and the baby remained high and immobile. It was time for the forceps.

I’ve seen forceps used a lot, but never quite so skillfully as this time. The baby was absolutely not a +4 – was possibly at a zero station, perhaps higher. The OB was using mid-forceps on the baby – it was easy to see because of how much of the instrument was inside mom. Without an episiotomy, she pulled on the baby with gentle force and we watched as the baby did the same odd heart rate pattern of falling in-between contractions while climbing during pulling and pushing. The baby’s heart rate was dropping into the 70s, but wonderful Jill never said a word and all mom heard was, “Heart rate’s over 115.” It didn’t register that it was over 115 and that was great news, just that it was over 115.

Jill put oxygen on mom and I encouraged her to breathe deeply in-between contractions. She listened well.

Neither mom nor dad knew how low the heart rate was going and that was just fine and dandy to me. Dips into the 60s and the low baseline being in the 70s was typical. Climbing up to the teens during pushing and pulling happened every single time. The OB and I looked at each other and waggled our eyebrows. She chuckled and said “This baby sure likes to be pushed and pulled,” to which mom replied, “She better, you’ve seen her sister!” It was a light moment in a time of growing concern.

Forceps were used for 12 minutes that I counted. I had never seen them used for so long before. She never asked for the vacuum and she placed and re-placed the forceps 4-5 times. Miraculously, mom never had a perineal tear.

At one point, mom made a comment that went something like this: Don’t make my baby a Sylvester Stallone – and I shot her a look of, “Good GOD, don’t say something like that! That’s lawsuit talk right there!” Amazingly, the doctor nor the nurse understood that she meant not to paralyze her child’s face with the forceps and just thought she was talking about the oxygen. Later, I explained to mom that no doctor ever purposefully paralyzes a baby with forceps or anything else. Accidents happen. Sure there are negligent docs using forceps, but this wasn’t one of them. She wasn’t teaching an intern or allowing a resident to have a hand at the tool; she was getting a pretty darned depressed baby out of her body as fast and as safely as possible.

Once we could see the head – now at a +3 or so – then the forceps were removed and mom exhorted to push the baby out on her own. The heart rate was still doing its funky thing, but at least an end was in sight – and it was a VBAC end.

Instead of using the metal forceps, the doctor used her hands as forceps to help pull the baby forward and down. Goodness, this child was being a challenge!

As glorious as this doctor was, one small complaint is all I have, but I wasn’t in her head, so can’t really be all that mean about it. She started doing some incredibly aggressive perineal massage... easily pulling mom’s vagina and labia out about 6 inches from her body. Over and over, she pulled and pulled and pulled her body – I thought I was going to be sick, she was pulling so hard. I say I don’t know what was in her head, but perhaps she was nervous and wondered if there really was enough room. Maybe she was nervous and this was her way of tending to the fear. Maybe this is her normal treatment of a vagina. If so, ACK! If I ever get the chance to see her again and talk to her, I will surely ask her what was on her mind as she manipulated my client’s body so aggressively. Postpartum, mom’s perineum was bruised so badly it looked like someone took a baseball bat to it. I’ve seen bruising and I’ve seen swelling, but it was nothing like this. From leg crease to leg crease and clitoris to anus, a hugely purple bruise along with some grand varicosities helped to keep mom off her butt as it healed. She had been sitting at the computer before I saw the extent of the bruise and could see one of the varicosities bleeding and explained that if she didn’t get off her bottom she could very well end up back in the hospital with a hematoma or worse. It was all she needed to lie down, where she remains a week later.

The baby finally moved lower and we could all see her crowning. I encouraged mom to open her eyes to watch her baby be born, but she couldn’t see over her belly yet. She tells it that as the doctor lifted her head upwards, then she was able to see her child. I pulled mom’s arms out from under her knees and towards her vagina so she could bring her baby out onto her belly. As she did, it was so wondrous and I wanted to shout with glee. “She did it! She did it!” It was news for all to hear.

I ran to the warmer for blankets (I think the doc asked for them as she was being born) and covered her as soon as she was out and on mom.

A massive amount of meconium followed the baby’s entrance into the world and the baby lay flaccid and quiet on mom’s belly. Jill took the O2 mask off mom and gave it to me and I put it next to the baby’s face, being careful of her eyes (mom and dad saw that, yes, it was a girl). Both Jill and I rubbed the baby and I went to get new warm blankets and we changed them out. I called one minute, but Jill said we’d already passed it and gave the baby a 6. I laughed and said she was a whole lot more generous than I would have been. By the time we hit two minutes, the baby was still not happily breathing (very gunky), but her heart rate was a fabulous 140. She was still totally flaccid and her color, while not horrid, still left a lot to be desired.

Somewhere in there, the OB said, “Short cord,” and the cord was cut – she told mom, “Don’t worry, I waited until it stopped pulsating.” Mom laughingly told me she couldn’t have cared less at the moment, was flattered the doctor even thought of it. (I can’t imagine a cord being done pulsating in less than 2 minutes, however – unless it was pretty flaccid to begin with.)

Short cord.

Was she pressing on the cord in-between contractions and then lifting off of it during the pushes and pulls? We’ll never know, but it was very reassuring to know that it was, indeed, a short cord.

sigh

“Carry her to the warmer,” someone said and I grabbed the baby and had mom kiss her before lifting her off mom’s belly and walking her to the warmer.

Never before, nor can I imagine ever again, will I experience carrying a newborn to the warmer. Me, a non-hospital, un-insured, not-under-contract person being asked to do something so supremely hospital-oriented – yet another moment of internal shaking of my head wondering, “Is this for real?”

I turned on the suction and the nurse gave me the DeLee to hook up to the tubing and she began suctioning as I stimulated and changed the blankets yet again.

The baby finally began perking up, but remained pretty darned quiet. I called dad over because babies always respond much better to their parents than to their midwives and he was so loving to her, touching her hand and hair and talking to her to bring her into her body. She never really hollered like many newborns do, but she showed her irritation and left it at that.

I went back to mom and saw the doctor already beginning to suture. Mom had a deep first degree vaginal tear. (I watched some of the repair and would have considered it a second degree.) Even with all the manipulations and forceps, she never did have a perineal tear. What a testament to mom’s nutrition and tissue integrity!

The baby was wrapped like a burrito and brought to mom – did she unwrap her and put her skin to skin again? I can’t recall, but all of us were giddy with joy and I was oh so happy for the VBAC and the doctor was sewing and mom was happy and the baby was fine and there was still no one there from Peds or the NICU. Grandma was talking delightedly, dad was sweating and thrilled – and I sat in the chair and cried for a few minutes… tears of relief and release. I just needed to cry.

Mom asked if the placenta was out and the doc said it sure was, it had come out at 5:45pm… the birth, we learned, was at 5:40pm.

6 hours and 25 minutes of pushing.

Do I count it like that? Or do I count it from when she was complete in the hospital? If I were at all inexperienced with vaginal exams, I would question what I felt while we were still at home, but I know what I felt – I know she was complete and then not complete. I know she was pushing from before noon. I wrote in her chart that she pushed for 6 hours and 25 minutes. She deserved every second of that time charted and acknowledged.

Amusingly, when we got to the hospital, the doctor made comments about the baby coming fast… that mom had been 8 and then complete in a very short time. When we talked about labor really kicking in about 4am, she said that was still really great for a first time vaginal birth. We all kind of looked at each other and I wanted to blurt out how long she really had been pushing, but I kept my mouth shut and let her believe what she needed to believe.

We were all so tired. I’d not napped at all in the 15 hours or so of active labor and immediate postpartum period. Dad wanted to go get the girls, so he and I headed off about an hour after the birth. I still needed to go home, to their home, and clean it up from looking like a birth room. Oh, to have an assistant!

As a midwife, I have always worked with an assistant, usually another Licensed Midwife. When I knew I was going to New Orleans, it was one aspect of the trip that was cause for concern. My client had just the doula that we could tap into, but she’d only been to 10 births. While mom was an RN, she wasn’t an OB RN. She was game for listening to heart tones, though, but I never had a chance to teach anyone how to listen because I remained awake the whole time.

Being sick, I’d explained to mom and the family that there simply are times when I would need to sleep. They all knew this and it wasn’t a problem at all. Until labor. When I would try to go into the living room, even for an hour’s nap between listening to heart tones, I couldn’t get anywhere near sleep before someone came into the room and looked at me with frantic eyes and I knew I was needed once again in the birth room. Dad, trapped under mom, tried to sleep in-between contractions, but didn’t get much sleep either. No one but the doula and the dogs had a nap.

When I arrived, I tried to see if we might find another midwife so I could tag team as I am used to doing at births. It didn’t seem palatable to mom and the one midwife lived very far away. I never did call her. I simply thought about all the midwives who work alone and thought if I needed help, we’d just get our butts to the hospital. It’s the same as my not having oxygen – it was the first birth I attended ever without oxygen. Well, the birth did have oxygen; it was the labor that didn’t have any present. I figured, again, if we needed oxygen, then we were off and running to the hospital.

Remember my list I wrote of things to take to a remote birth site? Those are the things I had at this birth. Now you can look at my supplies through knowing eyes.

When dad and I were on our way home, mom called and said the baby latched on with a delicious slurp and hadn’t let go yet. Dad was so excited and tired, he almost ran into a car in front of us twice. I had to grab his arm to pull him from his reverie to stomp on the brake!

Once back to their house, I cranked the air, turned on the fans and cleaned up the birth supplies. I put my things away, sat and charted, changed the bed, started a load of laundry, washed the dishes and then took a shower and went to bed out in the RV I was staying in. And I slept.

Mom came home 2 days later (she would have come home the next day, but her leg was some numb from a tweaked femoral nerve).

At a week postpartum, she remains happy with the experience, still somewhat in disbelief at it all. Dad is happy… glad we went to the hospital finally. He said it was so difficult enduring his wife’s increasing pain. I told her I never really saw her as in pain, but just in kick-ass labor. She said she could have gone without the epidural just fine if it hadn’t been for the horrid three-point stabbing going on. Of course, with all the genital manipulations, it was a darn good thing she did have an epidural in place! Grandma is also very happy and so glad it turned out the polar opposite of the last birth experience. Mom worked so hard to create a birth team that supported her belief in a VBAC. I was so honored to be a part of that team.

She had her VBAC. Yes, she had her VBAC.

The baby weighed 7 pounds 7 ounces. So much for not birthing anything bigger than 6.5 pounds. I told her she should send the old OB a birth announcement with both mom and baby sticking their tongues out. While she won’t be doing that, she is going to send her a VBAC birth announcement.

She had her VBAC.

I am so proud.

The Story (a homebirth)

2006-06-14T14:35:00.000-07:00

I gathered up my apprentice and assistant and we presented at my client's doorstep at 5:55am. The household was up, but stumbling around - mom was in the shower. We chatted briefly about what happens if there is an emergency as I broke the water (dad brought it up) and I talked about 911 versus taking the car... and where we would go (a local hospital where her SIL is an L&D nurse). I asked if there was any reason in particular he felt we should talk about it and he said he just wanted to be prepared.

Mom came down and we did a few minutes of listening to the baby, doing vitals, and talking about how this was the last tool I had in my arsenal towards bringing on labor - the next step was the hospital. Mom and dad knew that and as we discussed the risks of rupturing membranes, they said they were ready for it.

We went upstairs and I did a vaginal exam and found the mom at 5cm, the baby LOA and 80% effaced.

Hmmm.

Actually, later that day, I realized she was really 100% effaced and had been from two days earlier. See, the cervix had an inner and an outer part and the inner was 100%, the outer was 80%. I would never have realized that if I hadn't done a vaginal exam during pushing and felt she was complete, but had that 20% puffiness still there. It was then I realized she had actually been 100% for the last couple of days. I'd even said to the assistant that it felt 100% inside, but I was taught to only go by the outer band. This time, the inner band was the true story.

At 6:57am, I broke her water with an amnio-hook. I tried to "catch" the bag on the right side of the baby's head (my right), but was too close to her head and her heart rate went down some, so I moved over to the left side where there was more water bulging. I snagged it after a couple of tries and the wonderful fluid was clear and beautiful. Plenty of it! I kept my hand inside as she coughed and laughed and water squirted out with every pressure move. We continued listening to heart tones throughout and the baby was great throughout. We had mom sit and then stand up, listened to the baby. Perfect!

Within 10 minutes, mom began contractions. Yay!

The apprentice and assistant and I went to IHOP for breakfast with the admonition to call us for anything - we were 5 minutes away. Mom ate some eggs and toast, too. We were excited sitting in IHOP - today?

When we got back, mom was in the tub (already?!) and contractions were 2 minutes apart and lasting for 90-120 seconds. Oh, my!!! Starting in transition, wasn't she!

She asked us to stop with the flash photography, so I put my camera away. She was just so beautiful! Her sister loved on her throughout the labor and helped her whenever she needed it (she's a therapist). We'd already set up several days earlier, so all we needed to do was be with the mom.

Mom told me she didn't think she could do this without an epidural. She just really thought she needed one. Knowing how fast she was going, I told her she couldn't get in the car, get in the hospital and get an epidural before the baby was born. She made some noise about it again (kvetching) and I asked her if she thought she could do these contractions in the car. She never uttered a word about leaving again.

Contractions were so fast and so close together and so long, I was always delighted her baby was happily galloping along inside.

Near when we got back from IHOP, the family was deciding who to call when. I told them whomever wanted to be at the birth needed to get there as soon as possible. I don't think they expected it to go so quickly because she'd labored for 20+ hours last time. As the family assembled, I only had to ask that people be more quiet a couple of times; the excitement was palpable!

At one point, several people were standing and I asked them to sit or squat down. Mom, lying in the tub, needed to be the highest point in the room. It was disconcerting having so many people towering over and staring at mom. I promised the aunt with the camera I would let her know when the baby was coming so she could stand up. I thought I made her angry, but later she said not at all. I felt I owed her a belated explanation anyway.

Mom began pushing and within a few contractions we could see what we all thought was head. However, it was white and I became puzzled as the heart tones were fabulous. One doesn't get a ghost-white head with heart tones like that. Mom felt inside and said the baby was "right there," but the only thing I saw was her ruggae bulging from her upper vagina (not a cystocele). I asked again about 20 minutes later and she said, "right there!" showing me the baby was a fingernail's length inside. I didn't think so, so asked if I could feel. She said it was fine, so I went in and found the baby at a +1. Much higher than she thought.

She'd been grunting, but not really pushing pushing. I waited for the urge to become overwhelming - her family tried to count and push her head down chin to chest - but I explained quickly, she was doing great - let's just listen to her.

Within another few contractions, the urge hit and hit good and I could really see the baby's head starting to peek out of her vagina. It wasn't white.

Dad had been in the tub - sitting on the ledge - but was very uncomfortable sitting there (and not just physically), so took one towel and then later, another towel and made a cushioned seat for himself. He wiggled and stood and sat and shifted his feet over and over until mom finally said, "if you want to get out you can." "I can?!?" and he jumped out and cleaned his legs off. (There were floaties in the pool - I think that was what made him most uncomfortable. The floaties were leftovers from castor oil, so not too fish net-able.)

As the head started to be born, it kept coming - and coming - and coming. She was in the water and the baby seemed to get hung up on the cheeks. When movement stopped, I hopped in the water and touched the head to see what the deal was - was there a cord somewhere I couldn't see? Is that what I feel? Nope, that's an ear. She began pushing again, harder and the nose came out and then the lips and finally the chin. Anticipating a shoulder dystocia, I encouraged mom to push good to get the baby out. She did not rotate except slightly and my assistant called out 30 seconds. I had mom stand and put her leg on the edge of the tub to no avail. 45 seconds. I told mom we were getting out, praying that the lifting over the tub would dislodge the shoulder, but it didn't.

I had mom lunge again, but she needed help, so we put her foot on the tub. No baby. McRoberts time. I asked her to get onto her back and the my assistant and her sister pressed down on the soles of her feet to open her pelvis WIDE. I pressed on the baby's head (body - not just the head or just the neck) with each change of position, but she didn't budge. In McRoberts, she remained wedged and my assistant called out 1 minute 30 seconds.

The baby's head began looking like a grape by the time we were climbing out of the tub Now, her head was nearly black from suffusion. I had a fleeting thought of a dead baby, but continued doing what I knew to do to free this child from inside its mother.

Finally, FINALLY, there was movement and the baby oozed out of her mother very slowly, trailing a huge amount of meconium she had just released during this experience. We left the cord pulsating for at least 2 more minutes (mom needed blood work done because she was RH negative, so we need to cut a tad earlier than usual to make sure we get enough blood for the test).

The baby girl lay motionless on the floor next to mom. Mom started crying as we grabbed the bag and mask, but it seemed stimulation might be all she needed. Thank god! We rustled her up and her heart rate was wonderful, but when we stopped annoying her, her heart rate went down to under 100. When she opened her eyes at about 30 seconds postpartum, I could breath a sigh of relief as we continued rustling her. She took her first breath at about 50-55 seconds. Her 1 min Apgar was a 3.

Blessedly, she was in primary apnea and she came around with stimulation. In secondary apnea, the only way to bring a baby around is with resuscitation. Everyone who does this work assumes the baby is in secondary apnea because you cannot waste time stimulating if the bag and mask is more appropriate. Happily, this baby showed signs of annoyance long before she opened her eyes or took a breath - small grimaces let me know she was "there."

Her short cord didn't allow for her to be on mom in the position she was in, so once the baby started crying crying (not just breathy squaks), we moved her back down and between mom's legs up onto her belly. The room was crying - me included.

5 min. Apgar was 7.

A separation gush let me know the placenta was ready to be born. Is that too much blood for a gush? sigh Of course, the adrenalin rush in mom didn't help the open blood vessel issue at all. Even though we all stayed calm and quiet, she got that it was urgent. I wanted to see where that bleeding was coming from and asked her to push the placenta out. I assisted its birth (thank god - again - that I know how to do this action) and the placenta came out Duncan. Ah, now that explains why there was bleeding! Another gush and I gave her a shot of pitocin and the bleeding subsided. (Mom is a freckled red-head.)

As the placenta was being born, the membranes trailed and as I began turning the placenta around to whirl it out of her vagina, her cervix poked out to say hello. Blinking, I called the assistant to look and removed the rest of the membranes easily. The cervix, deep purple and red, was already closed down to about a centimeter (looking just like my cervix flower picture!) and was still inside the vagina, but right at the introitus. I put my fingers on the side and said, "Let's put you back where you belong," - mom eep'd and I apologized. I told her in private what had happened and told her if she felt it while wiping, that's what it was and it should recede within a couple of days. We gave her sepia (a homeopathic) and the recession seemed complete by 3 hours postpartum. Hurrah!

We cleaned mom up some and then she walked to the bed while dad held the baby. She got situated in the bed and her baby was handed to her again, naked and HUGE. As soon as she was born, I said she was over ten pounds. Looking at her again, I shook my head at her size.

Asking if we could weigh her soon, mom and dad also wanted to know, so my apprentice grabbed the scale (a fish scale) and we weighed the baby: 10 pounds 8 ounces. Whee-Ha!

Her face was still diffused and we found a long bruise on her upper right arm (going over a bone or two?) so I asked if I could give the baby a Vitamin K shot- mom agreed and I gave her one. She never even flinched.

For a variety of private reasons, mom was going to mix formula and breastfeeding and had bottles close by. Because of her size, I encouraged mom to feed the baby sooner than later. She had tachypnea (breathing fast) and hypoglycemia can send a baby into full respiratory distress quickly and dangerously. She fed the baby a bottle about 20 minutes after the birth and she drank 2 ounces in moments! Mom put her to the breast after that and she was absolutely in bliss. Respirations slowed and all was well.

The baby's temp was some high for awhile, but removing clothes and such resolved it. I worry when there is TTN (transient tachypnea of the newborn) mixed with another sign of distress such as a fever - indications of possible infection), but she settled with nursing and removing clothes helped with the temperature.

Mom had another bout of bleeding that raised our eyebrows, so we gave her another shot of pitocin. It seemed to have done the trick. Finally.

I knew mom needed to be sutured and she didn't care. My apprentice went out to the car to get Anne Frye's suturing manual and I told mom not to be concerned that I was studying before the job because "I always bring this along" which is true, but I don't usually open it! This time, I was ready! I didn't even break a sweat this time suturing... wasn't nervous at all. My assistant was my suture doula and helped me piece the vagina back together visually as well as coaching me while we were going. The advanced suturing class she just did paid off wonderfully!

The tear was a deep first degree and looked like a Y with the inner labia being the V-shape and the leg of the Y inside the vagina, but not terribly deep. For the first time, I didn't get all namby-pamby about exploring the vagina, either. I apologized, asked her to tell me if I needed to stop and then went in when she was ready and did the job I was hired to do.

I explored the posterior fornix which felt like it had blood pooling there, but I didn't feel any pumpers and when I sopped it up with a gauze "tampon," it stopped bleeding as much. I found two skid marks in her upper labia, but those didn't need repairing.

I put some arnica gel on the areas I was going to suture and then injected lidocaine the way Anne Frye recommends... tiny pokes with minimal solution being injected in the tissues to keep swelling at bay. It worked! She didn't feel the suturing except right at the end and only at the upper labia area for one stitch. She had a couple of varicosities I had to dodge, but did that just fine, too.

The next day, my assistant and apprentice (who did the 24-hour postpartum visit because I was in New Orleans) said you could hardly tell she had even been sutured! They said the swelling was gone and her vulva looked perfect. Mom checked herself out in the mirror and was very happy with my suturing job. I'm beaming. See me?

One thing seems to be a skin tag might be near the edge of one of the sutured areas. The suture doula pointed out that I needed to pull it up and I tried, but it didn't stay there. She told mom yesterday a doctor can slice it off at 6 weeks postpartum, but I don't know if she told her that most tags like that shrink so well you can't even see them anymore. Let's hope this one is like that.

The apprentice and assistant cleaned up the room, mom's family cleaned the bathroom (we'd made some mess what with jumping out of a tub to deliver a baby and then having some bleeding and delivering a placenta) and then I did the newborn exam (about 2.5 hours postpartum).

We stayed for just shy of 4 hours postpartum and took our leave gleefully and thankful to the Universe that lets babies live even when they have a hard start.

The question comes up about why so many shoulder dystocias... especially, why do I get so many shoulder dystocias? I wish I knew why I got so many. I honestly believe it isn't a "to think is to create" issue, but perhaps babies are getting so big, there is no way I couldn't get a shoulder dystocia now and again.

You know how some photographers specialize in wedding photography? Others specialize in kids or pets? Well, as a midwife, I specialize in shoulder dystocias. Other midwives I know specialize in hemorrhages or twins or breeches. Sometimes, there is just a special skill we possess - and who knows why. I sure don't. Why do some lawyers become pro-bono altruistic attorneys and others represent OJ Simpson? Why do doctors specialize? Because something resonates inside them.

From early on, I have seen and known what to do about shoulder dystocias. I think it is so frightening for so many, I took a special interest in handling it quickly, smoothly and correctly. There is no room for error - no time for bringing in an Anne Frye book and having a shoulder dystocia doula. It is me and me. Assistants help sometimes, but generally, it is me.

I joked that perhaps my midwifery services should come with a shoulder dystocia disclaimer, but isn't that setting them up for it?

My premonition (intuition is what another reader called it) didn't play out the same way as it really happened. I saw no success in the resuscitation. I did not even see a shoulder dystocia or a big ol' baby. But, I was ready. I feel I was no less ready than any other time, though.

In the Yay Is Me vein, the family was so grateful and kind about the whole experience. We all knew what would happen in the hospital had the same thing occurred. A circus of loud proportions is how they are handled in the medical world. Blech. Mom, while knowing things were serious, didn't quite get how serious until hours after the event. I'm so glad!

She said she knew when I jumped in the water, something was up... and when I told her to stand and lunge and get out of the pool and lie down... something was REALLY up because she knows I direct women virtually never - never, certainly, without reason. She was a delight and did exactly what I needed her to do when I needed her to do it. She said that was the trust she had in me - that she knew if I asked for something, it was for good reason. The trust on my end came from doing the birth at home in the first place and then believing if she needed to do something for her own health and safety or her baby's health and safety, she would do it. And she did!

While I merely did what I was trained to do, I am very proud of myself. Instead of gloating with the family applauding, I turn as much as I can on the mom, thanking her so much for believing in me, for moving where she needed to, for talking to her baby, for growing a healthy baby, etc. Pride, while okay for a flash of a moment, has a way of coming back to haunt you.

Now I sit in New Orleans, waiting for this mama to deliver... waiting patiently. I am enjoying myself immensely. Lots of time to read blogs, sleep, write, sleep, and spend time with myself. Her family is a delight - it's going to be a good birth (a VBAC).

Hospital Birth

2006-05-19T04:50:00.000-07:00

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

2006-05-19T04:41:00.000-07:00

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

2006-05-19T04:32:00.000-07:00

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?

A Baby & a Nap (homebirth)

2005-10-24T14:39:00.000-07:00

Sunday morning at 1am, a woman called saying she was a nurse and during her shift, several calls from my cell number came in and she wanted to know who I was. It was from the 714 area code and the only people I know in that area are some of my daughter's "friends," so was worried and called her at 1:30am. She picked up right away and was doing fine. I was relieved. It's amazing how my mind works even totally asleep: daughter's in the hospital, her friends don't want me to be notified and they see the nurse talking to me and hang up on me and threaten her if she calls me again. I heaved a sigh of relief that she answered. That she answered on a Saturday night meant she hadn't gone to a Rave that night. Yay!

I went back to sleep and was awakened again 90 minutes later by my newest client who was also due (she'd left the hospital midwives a week and a half ago because they were squawking about her baby being macrosomic [HUGE], her BP being horrible, blah blah blah). While she did have some BP issues a couple days earlier with me and we spent 5 hours in the hospital getting labs done, all checked out perfectly fine and we left feeling very safe and secure about how well she really was.

We arrived at 4:30am yesterday, set-up while having comical issues with the fishy pool that wasn't blown up yet (including "discussions" with dad and the pre-schooler about the location of the pool - while mom kept insisting on its location even as she labored), and kept busier than usual for a pre-birth ritual set-up because of the pool. Note to fishy-pool birthers: BLOW IT UP AT 38 WEEKS!

The pool, finally blown up, was filled to ankle deep before the water heater gave up all the hot water (and we did ask them to crank the heat up). Mom didn't get in the pool despite wanting to birth in the water; ankle deep just didn't seem so comfortable after all.

We took her BP once before the birth and it was 130/90 - perfect compared to other blood pressures from a few days earlier.

The baby was doing well - the FHTs ran about 120 during the 10 days I knew her, slightly lower at times, including on the monitor at the hospital, but when we heard her starting to grunt a little and I listened, his heart tones of 80 got me to throw a glove on and do an exam to see where we were.

1. Is she pushing and the baby close so we can get the baby out?
2. Is she 3 cm. and we need to call 911?
3. Is there a prolapsed cord (despite membranes still being intact)?
4. Get her to change position.
5. Get oxygen on mom and resuscitation ready for baby if birth is close.

These thoughts and a thousand more flew through my mind in a split second as I did an exam and found her 8cm/80%/0 and asked the other midwife to find the baby's heart tones. While she looked, I felt through a contraction and tried to open her cervix with my fingers - not hard, but it did hurt mom and she said she really wanted me to stop, so I did. The midwife wasn't able to find the heart tones, so I stripped the glove off and found the baby - 60 to 70 now. My mouth got dry and I asked the other midwife to glove and go in to stim the baby. I'm now lying on the floor under mom, between her legs as she leaned on the dining room table. The midwife said she was 9cm, but that the cervix was thick. I moved just in time to avoid drinking the mom's clear fluids as her water broke (coincidence, no pre-knowledge), yet remained on my back under the standing mom. The apprentice said it looked like I was checking the oil in a car because I was not only under mom, but under the dining room table, too. She made me laugh later at that vision. Not something I even considered it looking like.

We put oxygen on mom (all of this happened in a 2-3 minute time frame) and then she wanted to sit down, so we got pillows and sat her on the floor of her dining room and within 20 seconds, saw the baby's head - slightly blue, but pinking up quickly. The baby was born in another contraction and he seemed momentarily stunned, but we didn't suction or need to do any resuscitation at all as he snuggled with mom. We took the O2 off mom and, amusingly, dad grabbed it and put it on his own face! The apprentice was closest to him and was helping him to center as everyone took a giant deep breath and fell into place with their son's birth.

This "macrosomic" baby was 8 pounds 8 ounces and nursed nearly immediately. Her BP went immediately down to 120/80 and was even slightly lower upon departure with the usual reminders about pre-eclampsia occurring postpartum, too, so to keep watching the signs and symptoms for a couple of days. I go back today after school.

Whew.

It was interesting taking someone on so late in pregnancy who hadn't ever had a homebirth before because there was so much to catch up on. For example, it was odd that they were going to take the baby to the lab to do the newborn screen. I wasn't able to explain the why's and wherefore's about why to have the midwife do it (love, gentleness, not having to leave home, etc.), so wrote an email explaining, while also tell them I am not trying to "sell" myself, because I don't make any money from it at all, but that because they would have learned this in the pregnancy and I am merely catching them up.

They are also going to circumcise. VERY odd for the type of family they are, but I also explained about circumcision with a mohel as opposed to going out and getting it done at the doctor's office or in the hospital.

I explained about the 2 week rest period - BabyMoon - and that she wasn't an invalid, but that she was "open" to lots of things besides germs... the mean and sad thoughts of others that can't keep control on their feelings and love to dump them into open vessels - as pregnant, postpartum, nursing, and bleeding women are. (I know she's going to think I'm a fruitcake, but oh well.)

(Postscript: I ended up doing the NBS and they chose to not circumcise!)

Brief Synopsis of Twin Birth

2005-08-02T14:42:00.000-07:00

Quick nice labor, pushing in the water, head born and then no movement. Mom stood and lunged. No movement. Mom helped out of the pool (watch that head!) and lunge again - no movement. Mom squatted deeply - no movement. Mom helped to lean back, and then back further as midwife felt for shoulder position and baby began rotation. Born 3 minutes after head. He had a nuchal cord.

Baby boy recovered well with stimulation and loving ensued.

I was in charge of listening to fetal heart tones of Baby B, so was right on him as soon as A's feet were out of the vagina. His heart rate was great, then good, then okay, then sad, then scary... so we moved her to the bed and got oxygen on her and the midwife felt for position (and cord) and he recovered within a few minutes.

We waited for contractions to return, mom nursed baby, and then nipple stimulation to bring on a contraction. Pushing began again about 30 minutes after the first baby's birth, but the baby didn't come down so easily, so we got her standing again and she pushed while we waited.

(On the bed, I had to lay on my left side - my horribly painful side - and collapsed at one point as mom readjusted her position and she also fell some - both of us right onto her husband's leg. He was a trooper and barely screamed in pain.)

As birth was imminent, I began photographing again and that's why I have pictures of Baby B coming out, but not A. He did great as he was born - nuchal hand/arm.

More loving happens. Joy! Happiness! Health abounds.

Then bleeding.

Then no placenta despite Angelica and later pitocin. Eventually, manual removal of the placenta is done - with too many clots.

Another midwife sutures as one starts an IV with pitocin.

We clean up the area, stay with mom who's hungrier than I have ever seen a woman be in the birthing time. (She ate about 3000 calories during labor - and continued eating postpartum, even amidst the bleeding.) We ran out of Chux (a first).

The placenta was amazing (as seen below) - Baby A was 8 pounds 8 ounces; Baby B 6 pounds 4 ounces. Baby B's side had a velamentous insertion (see photo below, too), but it all worked out great. The placenta looked rather old, too... very used up. No wonder mom ate so much!

Mom nurses - all seems pretty stable, but she is some weak, but keeps eating and drinking.

We had a CNM, 3 LMs, & an apprentice at the birth. One LM and the CNM left 90 min after the placenta birth. I left 2 hours after that.

I went home and cleaned and sterilized the midwife's instruments and slept during the cooking. I got up, showered, dressed and went back to the woman's home where I found out she'd been to the bathroom to pee, but had been carried there! She had to pee again and was put in an office chair and wheeled there.

Red flags!

Around 6 hours postpartum, she had a slight fever, so another IV was started with antibiotics.

Her vitals were good, then poor, then good again. It was time to go in.

We called EMS (after discussion with dad, mom, then family) and they transported mom via ambulance; the twins went in the car with Auntie (mom's identical twin). Auntie followed me in my car. (Her midwife was so wiped she couldn't see, so I offered to go in for her. She was extremely grateful. Shoot, she'd do it for me!)

Admission went well. Respect seemed apparent, but I have a feeling the staff had an in-service or two about pretending to be nice to our faces - their dealing with us later. Initial bloodwork showed mom's Hemoglobin of 6. With informed consent, mom accepted blood - 2 units. Mom also had a temp again, so antibiotics were started.

Mom and baby were never separated. Yay! She continued nursing well. Peds came to check the babies and they gestated out to 44 weeks (dry, peeling, skinny, soles of feet totally covered in creases, hard cartilage in their ears, etc.).

And she nearly fainted from being NPO while they waited to decide whether she needed surgery or not (manual exploration? D&C?). Once permitted to eat, I saw her tray on the nurse's station and asked the nurse for it. She said she'd have to check first if it was hers. I suggested she find out fast before mom eats one of the mattresses in the room. "Take it!" the nurse said. So mom began eating again. (Mom is a vegetarian and had NO processed food in her home - they ate magnificently. When I put my Diet Coke in the refrigerator I thought an alarm might go off or it be ejected into my face or something. It was to her, and the babies', benefit that she ate so much and so well.)

And they put a Foley in and there was 1600 ml of urine!!!!!! She easily peed that much at the house (an hysterical story all on its own - her peeing), but she was so swollen and immediately began ridding her body of it all.

Once stable and settled, I made sure they were good and left about 3 hours after arriving at the hospital.

Her midwife and I went to the hospital today and they are great. Mom is still on antibiotics, but should be home by tomorrow night.

The babies are so wonderful and loved... and their sisters are missing them lots. It will be good for all to be together again.

Funny, this birth, while twice as odd/scary/fierce as the one 2 weeks ago, didn't scare me nearly as much as that one. Probably because it wasn't my client? Because this family was gushing with respect and kindness? Because the client decided not to transport when the placenta wouldn't be born... because they were comfortable with their waiting... not sure yet all the reasons why.

Processing still.

Interesting that I continue believing that birth works. Talking with others, I watch limitations and boundaries fly up - no more twins! no more long placentas! no more than minimal bleeding! no more dizziness!

Sometimes this is so confusing.

And it wasn't so brief after all.

Jewish Birth

2005-07-28T19:13:00.000-07:00

I was invited to a birth 60+ miles away, as an assistant to one of the other midwives. I'd done one other birth with her and it was really nice, so I knew it’d be great.

This couple was different in that the husband was a Rabbi. They had several other children and had had the other home births with a different midwife, but chose this midwife for a variety of reasons – she is an Observant Jew herself (her preferred term – most of us would call her “Orthodox.”)

Prenatally, I was asked to wear something conservative to the birth. I chuckled inside since I can’t recall any birth where I wasn’t discreet – ever. She mentioned it more than twice. Finally I told her I would be fine, wear scrubs and she didn’t mention it again. I’d planned to wear a head-covering, but lost it along the way (more on that in a second).

I was given a head’s up about her labor, but that I wasn’t needed quite yet. I drove up and was going to stay at my sister-in-law’s house close by, but instead found the house I was going to and then drove to an AM/PM to nap.

I love my Explorer. Pillow, blanket, soft music… I can sleep well. I’d sleep better if I could put my feet up, but sometimes we can’t have it all, right?

I put my sunshades up (to keep the convenience store shoppers out of my sight) and went right to sleep (it was after 11:00pm).

I awoke with a start to screaming and pulled the sunshade aside and saw a man and woman fighting (physically). I grabbed my cell phone and called 911 – along with the other 8-9 on-lookers around me. The fighters ran across the street, leaving a friend/relative in the car (it was running, lights on, etc.) and he got out of the car and took off after them.

While waiting, the boyfriend (?) drunkenly stumbled back covered in blood, sat down on the curb close to my car and the deputies finally got there to talk to him. I never saw the girl again. Or the third person that got out of the car.

I talked to a deputy and shared what I knew, what I saw, who I was – and then the midwife called and said, “come now!” so I had to go. As I drove off, I noticed my scarf had fallen off and now I didn’t have time to put it back on and adjust it properly. They’d just have to deal with my bald head.

I settled myself before entering the home (a combination synagogue/living quarters), went to the bathroom, washed my hands, and then went upstairs.

This was a house. A regular house. In a neighborhood. And it was messy. Sure, there are kids living there, but it was messier than a typical messy kid house. I was surprised. The foyer had a ceiling that surpassed the second floor and as I sat on the second floor’s hallway overlooking the foyer, the ledge across the space held socks, toys, and loads of dust bunnies. Interesting.

(It reminds me of the really messy messy house owned by extremely conservative Christians – this house was nothing like that, by the way – but what happened to “cleanliness is next to Godliness?”) If it was Thursday (before Shabbat), I’d be more inclined to think it wasn’t a typical day, but it was after Shabbat, when major cleaning is supposed to be done.

So, I knock softly to let the midwife know I am there and when a contraction is over, she opens the door and introduces me to mom and dad. I then step back out and sit on the floor in the hallway, reading Weight Watcher’s magazine.

Sweet moans waft through the walls in crests and I hear mom getting closer to pushing her baby into the world.

I know a little about Jewish births. I know that privacy and discretion are important and that blood is an issue. I was comfortable with all of that and was ready to do what the midwife needed me to do.

I heard mama pushing and the midwife talking softly to her, saying she could see the head. The midwife called me in and I tiptoed in, hanging close to see what she would need.

Before the birth, she told me she really likes to do as much of everything as possible unless there is an issue… baby, mama… and I knew this as the baby was being born.

I put gloves on and waited just to her side, sort of behind mom, but dad kept looking at me smiling and saying the most loving and encouraging things. Mom made a comment somewhere along the way that she couldn’t believe she hadn’t even had one vaginal exam – that she’d had several with the other births including a cervical lip being pushed up for a long time with at least one of the births. She said this was so different! So great! And she pushed, without ever being told she was “complete” or that she had “permission” to push.

Her lovely daughter slid into the world, no tears, dad thrilled (I’m not sure where the kids were… asleep? Somewhere else?), and soon after the birth, when the cord had stopped pulsing, it was cut and dad took the baby out of the room so we could quickly clean mom and the blood up so the dad and baby could be with each other again.

It was fluid and easy… not a big deal at all. We washed her feet, washed her hands, I put peroxide on the carpet and towels, covered the soaking blood with clean towels, the placenta was born, her pad put on, she was wiped down once more and then a new cover-up put on, sheet pulled up and dad came right back – maybe 4 minutes? 6? Not much more than that. It was coordinated and easy-going.

I took the instruments and cleaned them for the midwife, gathered up dirty things and garbage and such, put things where they should go, cleaned her doppler, etc. and then thanked the parents so much for the honor of attending their birth, asked the midwife if I could do anything else and when she said, “nope,” I headed back home at about 2:00am (might have been a tad sooner than that).

It was a sweet birth. Quick. Uncomplicated. Respectful. Loving. And another different birth than I’d experienced before.

Another UC Story - as written to me

2005-07-12T05:46:00.000-07:00

UC birth of an 11-pounder – told to me, then sent to me, and I was requested to keep her anonymous. But, this is her story in her voice. She sent me the pictures to share and asked that I include them with the story.

My second child was a planned unassisted homebirth. How that came about is a long story for another day.

I was fearful tearing at the scar tissue from my horribly managed first birth, and my preparations for this birth included stretching my vaginal tissues with an Epi-No (basically an inflatable sex toy) and taking evening primrose oil and occasionally using it in my vagina as well.

The night before his birthday, I noticed some painless contractions with pressure. This was a new one for me. I was at 41+0. With my first baby, I started labor at 41+2 after feeling first contractions at 41+1. So I was expecting the baby any day.

I slept in the front bedroom (I'd had a bad cold that week and had moved in there) from about 10pm to 4am, a pretty good stretch for pregnant me. I turned on the light and read the fifth Harry Potter book and was just about to turn off the light again just before 5am, when I heard my fifteen month old daughter wake up in the family bedroom. I switched beds.

I had nursed my daughter for about 20 minutes when I felt a RIP SPASM RIP SPASM with a sensation like the baby jerkily pushing on the top and bottom of my uterus at once. I thought I should go listen to the baby with my fetoscope and make sure he sounds good. I unlatched my daughter and started to sit up to get out of bed but when I felt the fluid rushing outward. I took a leap out of the bed to save the sheets from getting wet.

I said to my husband, "I think my waters broke." Of course there was no "thinking" about it. They were ruptured. He said, "Are you sure? What does that mean?" I said, "That the baby will be born today."

I didn't have to wait for contractions; one started as I walked to the bathroom to check the fluid color (I'd been wearing a pre-fold in my underwear to contain any urine leaking from my coughing fits that week and there was nothing to clean up). It was nice and clear. The contractions were those lovely easy cramp ones that just barely hurt. I was very relieved because although I was prepared to wait for weeks if I PROM'd and had no signs of infection, I was just glad that for my first UC things were going the way people "like" them to.

I went into the kitchen to make breakfast for my daughter and my husband got up and tried to adjust both to an early rise time and to the news that he wouldn't be going to work. I carried a chux pad or a towel around with me to sit on. My daughter and I ate eggs and cheese as I eagerly anticipated calling my mom with the news. My aunt and Mom were both staying in town and would come over most days around 8:30 or 9am to help with the baby and the house and be with me. I wanted to call late enough that they would get all their sleep, but early enough that my aunt could plan a day without Mom, because she (my aunt) was not to attend the birth.

I called Mom about 7am. I loved hearing myself say that the baby was coming today.

I listened to the baby once, and his tones were good.

Mom came about 8am and I was leaning on the counter during contractions humming, but not because I needed to yet. I was just having fun.

My husband asked when the baby would come and I guessed by five. He packed up our daughter and went off for a day of fun, starting with breakfast out and then the petting zoo.

I hung out on the counters chatting with Mom until a little after nine, when I decided to get into my hot tub in the borning room I'd set up. This was my private space where no one could enter without permission. Within a few minutes, I was weeping with emotion and singing and dancing in a continuous activity that hit some peaks during the contractions but continued through each space between contractions with the same -- quality. I was singing open, open, open and weeping with the intensity of my ... pleasure might be the right word. Pleasure at being in labor, pleasure at being a mother, pleasure at being alone. They didn't hurt very much yet so I don't want you to get the wrong impression when I describe it as intense. It was emotionally intense.

Suddenly at about 10:45 or 11am, the emotional intensity turned off and I suddenly felt very normal and very sleepy-tired. My contractions, not close together before second stage, seemed to space out a bit more at the same time and I wondered if I could lie down and take a nap. But I hesitated so long each time between contractions that by the time I tried to approach the steps out of the tub, another contraction would hit. So I was tired, somewhat bored and not sure what I wanted to do right then.

Suddenly my mom walks in kind of cheery talking about some phone call she had with her sister. I said, "You aren't supposed to do that! But right now I want you to stay and talk to me." I considered my options and ordered a cheese sandwich and a peanut butter sandwich. She brought them back to add to my poolside table stock of weak Gatorade, water, liquid calcium, cal-mag, vitamin C and Rice Krispy treats (I'm sure there's something I am leaving out from what I consumed in labor). I ate a couple of quarter sandwiches and accepted some neck and back massage while still in the hot tub. It was still not emotional and I was laboring by moving to the other side of the tub when a contraction was going to start and doing my water-labor move -- holding the side of the hot tub and shaking myself forwards and backwards while moaning.

I moan really well and I never suffer while I'm moaning. If it hurts more, I just moan louder and it covers up the pain.

I still wanted a nap and asked if we could move to the living room. I had two identical nightgowns for laboring, one "wet" and one dry. I changed out of my tub gown into my land gown and to my pleasure was able to manage contractions lying on my side on the couch. I dozed in between contractions while Mom massaged my feet and legs.

Before I forget, I want to tell you about these contractions. In my first labor, my contractions felt like a bell curve. In this labor, they were always (once they had clear sensation) 0-90 in five seconds and almost immediately started sloooowly backing off so that they hurt for about I'd guess 30-40 seconds. They were VERY short and well spaced. About an hour before he was born, I think my mom said they were 4-5 minutes apart by my soundings. She thought he wouldn't be born until about 6pm.

While I was lying on the couch, my husband and daughter came home briefly to change clothes before heading out to a restaurant for lunch. Dad put a blanket over our child’s head so she wouldn't see me and ask for Mama, and they rushed in and out.

I spent maybe forty-five minutes on the couch and then decided to go to the bathroom. That was very difficult. My contractions got close together when I tried to do that. It was a challenge contracting in the bathroom and I decided I wanted to get back in my tub. I was going as fast as I can but still had two more contractions before I could climb back into the hot tub. I think Mom was with me to help me change back to the wet nightgown but then she scrammed upon request.

I was back into that emotional place again for about another hour or hour and a half. Contractions were more intense at this point, but in neither of my labors have I ever had “transition.” I don’t throw up, I don’t shake, I don’t say I can’t do this. But during this time, I was only singing and dancing and weeping with joy in between contractions. When a contraction came, I threw myself at the side of the hot tub and just started sounding with all my might so that I didn't have to hurt.

And suddenly, for about a half hour, I left that emotional space like I had late morning and was just kind of bored and laboring. I was quiet, looking around almost bored in between contractions and sounding like crazy during them. And during the contractions, I very distinctly felt my pelvis being pulled open evenly in all directions. Hmmm, I thought. Very interesting. No pressure though. I can't feel the baby pushing on anything. I had been checking myself toward the end but just felt head and a really stretchy, painless womb opening for maybe the last half-hour or hour of labor. I couldn't figure out how to get to the posterior side of the head to feel actual dilation so I just contented myself with exploring my baby and my body.

This is such a minor thing, I left it out of the first draft. Probably five or six contractions before my body started pushing the baby out, I had this thought and feeling "I need to poop and pee and that will make me feel better and that will make the birth easier." It is the same feeling I had the night before labor where I felt right before bed: if I could just empty my bladder I wouldn't feel this pressure with the Braxton-Hicks contractions. But during labor, it wasn’t pressure. Well it might have been, but I would never have said “oh I feel all this pressure” like some women do in their births. It was very subtle. I tried peeing and pooping in the hot tub after a contraction but nothing would come out. I was momentarily frustrated and scared because after the first birth (where I pushed for hours on a full bladder), I wanted to have an empty bladder to birth past, but then I decided not to worry about it and I did not notice it after that. (I think if I had said to a typical midwife, I have to poop, and she had said, “Oh, that's the urge to push. Start pushing,” that it would have been a damaging wrong thing. I also think (now bear in mind this is my first experience of actually giving birth and actually getting to feel a real, full first and second stage), that if I am lucky enough to birth a third time, that since I don't go through transition, maybe that will be my signal to prepare for birthing -- when I get this sense that I want to be empty.)

Then I felt the warning for the next contraction and grabbed the side and started to sound and rock when THE BABY'S HEAD FILLED MY VAGINA. I was like, “OOOOOOAAAAAAAAAAHHHHHHHHHHH MOM GET IN HERE! I WANT YOU HERE NOW!!!!” My vagina went from being empty to being completely full of head in about ten seconds. She hustled in and I told her the baby was coming and, “GET OVER HERE AND HOLD ME UP.” So she kneeled by the hot tub and I put my arms around her body and she held my shoulders and that's how I birthed the head over five or six contractions. The contractions were still short but much closer together and all I could do was hold on and holler. When I hollered, the head moved down. When the contractions were dying down enough for me to stop hollering, the head stopped moving. His head was way outside my "body" before he was clear of my perineum. It was so wonderful because it felt SO right and I knew I was not going to be harmed. I didn't have to push; my body would do that for me in this very mysterious, perfect way.

On the fifth or sixth pushing contraction, his head finally cleared my skin. I would say this was about 10 or 12 minutes into second stage, since these short pushing contractions were frequent. I recall being able to have short conversations with Mom between contractions, four or five statements apiece, before he would start moving down again. I remember as his head was being born, there was no pain in between contractions as long as I did not move. At one point between contractions during the birth of the head, Mom asked me if we could move a foot to the left so that she could kneel on the steps (that's right, she was being forced to stand during contractions to support me where we were) and I tried, but cried out, “stop!” because it hurt. But with my body suspended in water and not moving, I was completely comfortable in between contractions.

I told Mom that the head was out. My eyes were closed and I backed away from Mom a bit and sat there in the water. I reached down to feel his head, located the landmarks of his face and felt him, willing him to start rotating. He stayed face backwards, not moving, not moving ... slowly he started rotating. He made the turn toward my right thigh. Good baby. I went to feel around his neck for curiosity's sake. My intention ahead of time was to leave nuchal cords alone.

Two loops of cord ... um, I don't feel a pulse here. It never occurred to me that that would be the situation so it affected me differently than it will in a third birth. I didn't like it.He had moved once during his head birthing, so I wasn't too scared but I wasn't happy and decided to try to do something. I believe I referred to this in the early postpartum period as my attempt at Stupid Midwife Tricks and I still do not know if I was doing the prudent thing; being benign but ineffective; or causing some type of harm or some combination of these. I just want a nice pink baby next birth.

Or purple, that will suit me too.

Just not white.

I do think that my activities probably slowed down the arrival of the next contraction. But since in my experience, delayed contractions hit harder, maybe that worked out for the best. He was a big baby.The first thing I did was tell Mom what my concern was and turn around and present her with my behind so that she could reach him underwater and I asked her to unloop the cord from around his neck. I was thinking at the time that this was "doing something" and maybe the cord would get moved and whatever was causing it not to pulse would be somehow changed.

She unlooped his cord and I felt it. Still limp. I decided to get out of the hot tub.

This is what I remember after I got out of the hot tub. I have thought about it, and I think this is complete and ordered. I remember getting on hands and knees facing the wall, and asking Mom to suction him with the bulb to see if that would make him start breathing while he was still inside me. I knew this was not a shoulder dystocia, but I remembered reading that sometimes when shoulders are sticky the baby will (not often, but sometimes) be able to start breathing on the perineum, which takes the time pressure off. And what I wanted was breathing baby. He made some mews of irritation probably right before losing consciousness. (This was really a bad experience for him and when he loses it entirely, I sometimes think he is remembering When the Bad Thing Happened). I hoped that meant he could breathe. I asked her if he was pinking up. She said no.

I got up and went to the side of the hot tub. I remember holding on to the edge of the hot tub and doing some squatting and kind of shaking myself to see if he would fall out. I remember trying to push in this position, but I had no idea how to push consciously and I felt I was not being effective and was just going to hurt myself.

I went back to hands and knees and asked Mom to see if she could -- (remember I am not a midwife) but what I was remembering is pictures on TV of babies with their heads out and the doctor has his hands all over the baby and is kind of pulling down on the baby's head with the mom supine and the baby slides out. I didn't want his head pulled on but I asked Mom if she could put pressure on one of the shoulders to see if he would come out. She went in and said, "I can hook an armpit." I said "Give it a little pull" knowing my mom never forces anything (from early childhood, my parents constantly told me not to force things or I would break them). She did and I said, “OW STOP.” I think this is where I got my skin split because I don't remember anything hurting the wrong way but this, if you know what I mean.

I think I decided I would climb some steps and see if he would fall out. I am not sure where I got the idea that he might fall out, but I was ever hopeful.

I was just about to walk through the doorway to leave the borning room when the next contraction hit -- I suddenly dropped forward to the floor without thinking and out he came. Mom said something cheery like "There it is!!!"

I was slightly lower than hands and knees I think, but it happened very fast. I turned around, scooped him up off the floor and started talking to him and rubbing his back and patting him. I had him stretched out lengthwise on the air mattress on the floor of the borning room. I was kneeling next to him on the floor thinking these thoughts: Oh dear, he is white and floppy. Oh my, he's big. Oh, look at that penis. Oh, look at my beautiful baby. I kept rubbing him briskly and I said, "Come on little boy." Mom said, "It's a boy?" surprised because she thought he would be a girl.

He stayed white and floppy with his eyes closed during this vigorous rubbing, turning over on my arm, and more rubbing and talking. I ended up giving him three lungfulls of air before he started screaming and turning bright pink.

The placenta detached while I was kneeling there because that's where the blood puddle was. I didn't notice this at the time because I was so busy working on him.

I moved to the air mattress and sat there holding him and rubbing him and trying to comfort him with the breast. I took off my nightgown, naked for the first time but not worried about being powerless now. I held him to my bare chest. He kept screaming. I said I wanted to get into the tub and see if he would relax if I put him back in the warm water. Mom helped me and then I asked her to go call my husband.

I heard her from the kitchen saying, “Congratulations you have a son!” She came back into the borning room and said, “He is three minutes away. They are just leaving the playground.”

My son was born at 3:20 pm

He kept on crying in the hot tub.

My husband came in holding our daughter and trying to get his bearings. The baby was still screaming. He said I should get out so the baby wouldn't get cold. I didn't want to argue about how 90% of his body was in 94-degree water, so I got out and got on the air mattress and covered us with the comforter.

The baby still wouldn't nurse and I wanted to use nursing to help with third stage. So I asked my daughter to sit next to us on my left side and nurse. She hesitated and then nursed for a minute just staring at her brother crying hysterically in my right arm and then burst into tears. The squalling baby was getting to be too much for me, too.

Our daughter went back to Daddy and I lay on my left side and tried to nurse him again. I asked mom for my cell phone and left a message (complete with screaming baby in the background) with an understanding midwife. She didn't answer so I tried another friend. She didn't answer so I hung up and just stared helplessly at my distressed baby and cuddled him and talked to him and tried to nurse him and willed him to please stop crying. I picked up the phone and called the midwife again. She answered this time and I told her he was born and probably a little about it, but mostly, "He won't stop crying! Why is he crying?" She said something like, “Sometimes their collarbones might break on the way out. Be careful with his arms.” And hearing "bone" "break" I said, "OK YOU CAN COME OVER NOW." (She'd said earlier in the week, "I don't have to wait three days or something to come see that baby, do I? I'm special, right?” And I said, “I don't know. Maybe, maybe not.”) And she chuckled and said she would be by later in the evening after registering her team for lacrosse league. So we chatted a bit and rung off. I told her he was a big baby.

Shortly after that, my husband made another you-should comment (I can't remember what it was, but I think it had to do with warmth or cleaning off blood or “why aren't you nursing him?” or something like that in an effort to be helpful in the face of a naked unassisted birthed wife and screaming baby) and I said, “You all need to leave me alone because I still have to birth the placenta without bleeding to death. I am going to go into the bathroom where we can sit under the heater in the ceiling.” So I did. And it was lovely in there and after maybe a total of three crampy postpartum contractions, I had an urge to lean over from a standing position and release the placenta, which fell painlessly to the floor.

He stopped crying around this point and was alert for five or six more hours, but really wouldn't nurse.

I called Mom in and asked her to hold the baby so I could take a bath and clean off. She sat on the closed toilet holding the baby in a towel with the placenta lying there on the floor. I hopped into the bathtub and took a quick bath. Within a few minutes, the baby and I and the placenta in a bowl were snuggled into bed. Mom brought me the rest of the labor sandwiches, relatives were called, my daughter came up on the bed to snuggle and nurse, and my aunt came over from the bed and breakfast.

I cut the cord at 3 hours under pressure from the family. At about five or six hours, I replaced the cord floss with a clamp because blood was leaking onto his blanket. When I clamped it (still four or so inches down the cord) in front of the floss, being very careful not to pull the cord, he SCREAMED. I won't be interfering with the cord on my next baby unless I have to for his safety until it is hard and dry.

I was getting tired and wanting to go to bed so I called the midwife to find out if she was really coming. She said she was on the road on the way so we stayed up a bit longer. Mom and my aunt left for their room, taking comfort in knowing that the midwife would be stopping by as an extra layer of "everything's good."

I was in the big rocker cuddling a sleeping newborn when my husband let the midwife in. She came up, eager to see him and I said, "He's a big baby." She asked to hold him and I handed him over. She said, “oh my, he is big ... oh my.” She put him in the sling for her scale and tried to lift it while sitting on the couch, but she couldn't. She had to stand up. Eleven pounds even.

You know, I almost always wanted to do for myself in this pregnancy. But at the very end of the pregnancy, I wished for (but never pursued) someone to give me a prenatal because I was tired of looking after myself. And after my son was born, I just wanted to partially hand over responsibility for things to someone else so I could just hold my baby and not feel guilty for not scrutinizing him. I wanted someone else to put a diaper on him and dress him. The midwife gave him a barebones newborn exam (he did not have a broken clavicle) and visited for a while before leaving us to sleep for the first time as a family of four.

After being woken and unwrapped and then dressed, my son was mad enough to do a first good nursing. But as I realized over the next two days, there were no really good nursings. He was tongue tied so eventually I gave up on stretching it and convinced the midwife to notch it for me when he was about 10 days old while I held him in place (harder on her than on me). His nursing improved immensely after that and he started catch up gaining.

And that is the story of the birth of my son.

Barbara asks:

Why wasn’t your husband there?

Birthing woman answers:

He wasn't there because his role in the birth was to mainly be helping with my daughter while my mother mainly helped me. For example, we discussed in a transfer my mother going with me while he went separately with our daughter, gathered up diaper bag and so forth and then gone and done insurance stuff while my mom stayed with me. It wasn't planned ahead of time that he wouldn't be in the house, but since I had gone into labor first thing in the morning, on a beautiful day, it seemed natural and appropriate that they go off together since my mom was there for me. I found it very peaceful to have the house empty. Had I given birth a few hours later, he might very well have been home. But when we discussed things ahead of time, he did not want to be in the room (our first birth was a rape, which I’m sure affected him in this matter). And I had a strong rule that I was not to be outnumbered at any time while birthing.

Barb asks:

Why didn’t your husband dress the baby instead of the midwife?

Birthing woman answers:

My husband will hold tiny babies, change babies diapers and clothes as asked, and so forth but he feels very unsuited to handle them until six months or so and before that he is afraid of their fragility or having them cry and he can't help. I left my son swaddled naked until my midwife friend got there, since she was going to look him over for me and I didn’t want him to have to dress, undress and dress again; and since I was not feeling like dressing him it seemed natural to impose upon her to do it. I did want him in a diaper before I took him to bed.

Barb asks:

Why don’t you consider this a shoulder dystocia? In your description, by every indication and sign you describe, it was a shoulder dystocia.

Mom answers:

This is a hard question for me. You’re the first to call it that, though I’m sure not the last. He was not turtling, he did rotate and when I talk about waiting for rotation, well he didn’t rotate immediately but he was a watched pot. I’ve just counted one-onethousand, two-onethousand … with my eyes closed. Remembering. Five to seven seconds passed before he started rotating. It only felt like forever. Time passed SO SLOWLY, and he birthed easily and in reasonable amount of time after the head was born. 90 seconds, two minutes? It felt like a long time between the head and body contractions, but I was moving quickly between those activities so it was just my perception.

I did not ever feel resistance on my pubic bone. The head didn’t come fast but I was holding back power while birthing the head. When I did get a contraction he slipped right out immediately without any voluntary pushing on my part. My sense, during the period when I was trying to get him out without a contraction, was that I had time to try to do it without hurting myself. He was mewing when Mom suctioned him, for example. There was a point where I would have started pushing like crazy with her pulling and I was almost there because I was running out of ideas and time seemed to be passing slowly; stairs were my last idea. But it didn’t come to that.

If I birth again, I don’t know. I’m still working out lessons from this birth.

You know, after writing all of the above I did a web search on “sticky shoulders” and found this:

Excerpted from http://192.220.73.80/archives/shoulderDystocia.html#Difference
At midwife deliveries (which amount for about 80% of births in my unit ) the shoulders are delivered by maternal effort and force of contractions in most cases. Typically there is a lull in maternal effort and uterine contractions after delivery of the head. The next contraction typically doesn't come for 90 -120 seconds. By the 60 sec definition almost all of these normal deliveries would be defined as shoulder dystocia, this must mean the definition is inappropriate.

Note from Barb

“Turtling” is when the head is born outward and then is sort of sucked back inside… a classic sign of shoulder dystocia.

A short note from mom says:

I would like to make sure the message is heard about how amazing my mother is.

Note from Barb

I have heard wonderful things about her mother’s presence and presence of mind during the birth a number of times. I know this birthing mom was very blessed to have her mother available to nurture and witness her own daughter during her daughter’s child’s birthing.

UC loss - as told to Me

2005-07-12T05:25:00.000-07:00

July 6, 2005

A long day.

I met with the woman who lost her baby during her UC today. It was emotional and painful for both of us; her to share and remember – me to hear.

She said I could blog and share her story where I felt it was important or could be heard. I will work hard not to dramatize what she said, either, but parts are dramatic and painful. And scary if you are pregnant, so you are forewarned.

We sat in my back office and I just sat and let her talk. She said she cried all the way up to see me and didn’t want to cry right away, but both of us did. I hugged her hard when I saw her in the hall, before walking back to the office. At times, it seemed right to touch her. Others, she felt inside her own space and I tried to honor that.

Nothing was linear, so writing it probably won’t be either.

After she talked for a few minutes, I wanted to touch base with her physical recovery. She continues bleeding (not unusual at 4 weeks, especially since she isn’t nursing). She took care of her milk production perfectly… with sage, ice, no pumping. It was horrible for her when her milk came in. I can’t even imagine. She didn’t tear, but she still feels twinges in her belly and vagina. Again, I reassured her that that is normal. I shared that she might “feel” the baby kick sometimes… she said she does (and cried).

She feels empty. Defective. Much of our talk revolved around her NOT being defective at all, but normal. Her body worked perfectly. I shared my experiences of other labors and births – she wanted to compare her labors and births to her family’s and friend’s… apparently they all had easy births that got easier with each baby. I reassured her that not everyone gets that. I didn’t! I reassured her that her body is perfect for birthing. She described horrible back pain (posterior babies?) and I let her know that some women do get that, too. She wanted to know if her attitudes and feelings during the birth were normal. She cussed and hollered in places… why doesn’t anyone else do that? Laughing gently, I told her that she was sooooooo normal! I think she felt better knowing she wasn’t the only one screaming FUCK in labor.

She said until today on the way up she couldn’t remember why she wanted a UC in the first place… and then she remembered.

The midwife she had during her first birth (not in California), while kind and friendly, ignored her birth plan during the birth – broke her water without permission, did extremely painful vaginal exams even after being told she didn’t want them, made her push on a cervical lip for a long time before the baby was even ready to come down, and kept her on her back. The midwife also brought an apprentice that S went to school with and S could not stop thinking about being naked in front of this person who knew so many of the same people. She said it was so hard to stay in the labor and birth – something she wanted to do so badly… and had planned for so hard. The midwife made comments that hurt… and laid her head down during pushing as if she had given up on S – S herself said she then gave up on herself when no one else seemed “there” for her. The midwife and apprentice kept talking about stuff during the labor, too. Nothing to do with S’s labor and birth… just life stuff. S said she tried to be a compliant patient and didn’t say, “shut up!” to them. When S got to the cussing, noisy part of labor, the midwife told her she was being too loud… SCARING HER BABY! (emphasis mine) She said her thought was, “Great! The baby isn’t even out yet and I’m a bad mother!”

She saw the midwife after the birth… took her baby to see her. She said she doesn’t have terrible feelings about her or anything, that she is human and was probably doing what she knew to do, but it wasn’t what she needed. So, she decided to UC instead. She removed the variable in the equation – the midwife.

As an aside, I asked her to please consider telling the midwife her feelings and experiences. She doesn’t have to now. She doesn’t have to over the phone. She can write her whenever she is ready, but that unless she tells her, she will never know and never change. This feeling I am going to share is confused with a lot of other ones, so it might not come out so graceful. I feel that midwife is at least partially responsible for that baby’s death. That if she hadn’t hurt S, S might not have chosen to UC. Sure, I know, the baby might have died anyway. There is no telling if anyone or anything couldn’t have kept that from happening, but what if? Even staying away from the culpability aspect, the midwife still should know that she hurt a woman’s spirit.

So, her labor begins and it’s 12 hours from beginning to end. Nearing the end, she thought about calling a CNM friend, but knew she wouldn’t be able to come (for professional and personal reasons) and thought about calling me, but thought I wouldn’t even remember her. I told her I’d thought of her often and would have known and come immediately. That made her cry. Me, too.

The baby moved throughout labor, reassuring her as to his health and well-being. She had been in fear during the first birth with the midwife – had zero fear this time. She felt safe and that all was great. Her husband was there and her 3.5 year old daughter was in and out once she was awake. She pushed for about 45 minutes (if I recall correctly) and her membranes were intact. She said that they presented… a huge bubble of water that her husband thought was the head… and she knew, finally, she was nearly there. She gets extremely tired at the end of labor, as most women do, and thought maybe she didn’t have what it took to push her baby out… that maybe she was abnormal that way. Not at all! Many, if not most, want to sleep and certainly a lot of women fall asleep in-between contractions – some even snore! – during the end of first stage and in second stage.

She wandered around, in and out of the water, leaning a lot as she labored with her major back pain. When she was pushing, she was in a standing squat… not terribly deep, but not standing straight up either. This is how the head was born.

She said that with her first, the head was born and the midwife told her to just wait for the next contraction to push again. A couple of minutes later, the contraction came and she pushed her out. This time, however, the head was born and then there were no contractions at all.

She felt the baby moving and looking back, she believes it was probably the last movements that occur as a baby suffocates/strangles/loses his/her oxygen… fast and hard. At the time, she felt, “oh, he’s moving!” and felt reassured as she waited.

Her daughter, watching the rare tv show, all of a sudden cried out from the other room… just as the baby stopped moving.

S said that in that moment, she began doing stuff to free the baby. She squatted, she went to hands and knees, then she lunged at least once… doing everything she knew to do. She then flopped onto the floor, butt flat, and pushed with her entire being as her baby came out. His head was purple. His body “perfect.” (I asked if his body was white… she just said he was perfect in her answer.)

She didn’t tell me minute by minute details, so some is missing as I re-tell it. And that’s okay.

She rubbed him up, but he didn’t respond. She tried rubbing him harder and he still didn’t do anything… no breath or anything. She remembers knowing something was very wrong and started doing mouth-to-mouth on him. Somewhere along the way, she told her husband to call 911. I don’t know where the daughter was in all of this.

She describes the EMS firefighters as they came in – all huge and yellow (as SO many women describe them!) – and she was on the floor naked and so was her baby. They asked her lots of questions as they began CPR on the baby… she stopped mouth-to-mouth when they brought the ambu-bag in. They wanted to cut the cord, but she said not until it stopped pulsating. She doesn’t really know if it was even pulsating at that time (I suspect not). She said that it was all in slow motion. As they worked on him in front of her, she focused on his fingers, staring at them… memorizing them. She looked at his ears… saw that one was folded over just like her daughter’s. She felt how soft he was. They asked again about cutting the cord and she said okay – she just wanted the baby to be okay, so one firefighter did cut it with a scalpel.

Questions – did you have a midwife? Answer – I was my own midwife. Question – Did you just feel the urge to bear down and come in here? Answer – No, I was in labor.

The husband was being questioned by 4 police officers in the kitchen. She said pretty much she answered all questions with “I don’t know” while her husband answered all questions he was asked.

Sarah, my cop partner, said UCers should practice “I don’t know” and “I want to talk to my lawyer” and NOT SAY ANYTHING ELSE except your name to law enforcement. S did it perfectly.

So, they are taking them both to the ambulance – they are still working on the baby – and she reached out to touch her baby’s hand and she said he was so cold! She was upset because he wasn’t covered and despite her extreme modesty, she pulled the towel off of herself and covered her baby, tucking it around him.

The ride to the hospital included listening to the EMS people talking to the hospital, confusing the story – saying she did have a midwife but they couldn’t find her, that she was wedged in-between the sink and toilet (she said that was stupid).

Once at the hospital, I think they took her one place and the baby to NICU. She said that later (45 min after the birth – 15 min after entering the hospital), they took (wheeled?) her down to the NICU to show her how they were trying to make her baby breathe. A very young doctor, matter-of-factly said something to the effect that “it has been a really long time that they have been trying to help him breathe and that it was unlikely he would respond… and if he did, it wouldn’t be a good thing” (something like that).

I don’t know if she watched them stop working on her son.

I know that her husband, who doesn’t cry much, cried as he went to hold his son for the last time.

I don’t know anything (yet) about her holding her son for the last time.

During another part of the talking with S, I asked if she had the picture the hospital took of the baby. She looked at me completely lost. I said, “Didn’t you get a picture of the baby?” and she said she did not. “Did you get a lock of his hair?” No. “The blanket he was in?” No.

I thought I was going to throw up. I didn’t tell her how angry I was that they didn’t give her these things. Even the towel she tucked around her son was thrown away. She has nothing but his ashes. To me, that is just wrong.

S said it took a long, long time before she realized he wasn’t going to breathe. She kept thinking, even at the hospital, that he would just wake up and breathe. She said it was so weird how it came over her that he wasn’t going to wake up.

And a lot of that happened during the time that they were all over her to deliver her placenta. It isn’t unusual to “cling” to the placenta as a child is dying (from my experience and what I hear from others)… or, conversely… to have a hemorrhage, especially after the shoulder dystocia. She knew if she didn’t deliver the placenta, they were going to poke her. So, she told the placenta to come and it did. They shot her in the arm with pit anyway.

And then, they wanted to take blood and start an IV and poked her TWELVE TIMES before getting the blood and IV started. At 4 weeks postpartum, she said her arms just now are un-bruised. She couldn’t even move her fingers afterwards from so much pain.

They dripped pit in the IV, too. She said at that point, she didn’t care anymore what happened. She wanted to die. Her daughter lay next to her on the hospital bed.

I know that she went home around 12 hours postpartum. During the stay in the hospital, she had to talk to the police and social services. I think she said the police came to the house again, too, afterwards, but once they answered the questions, they haven’t been bothered again.

(Sarah said that had they had a different group of cops, they could have made it evil for her… taking her to the Women’s Jail… just making things very difficult for her. Blessedly, everyone that she had contact with were decent enough. Even the doctors told her that babies die from shoulder dystocia in the hospital or with a midwife… and that no one wanted to make her feel guilty, but they just needed to ask a lot of questions. CPS has had no contact, as far as I know, with the family. If they haven’t come by now, she can breathe easily.)

I don’t know when they had their 8 pound baby cremated, but dad went to pick him up.

She said she has a new respect and love for her husband who has been nothing but incredibly loving to and for her. He holds her anytime she needs it.

Her daughter is working through things herself. She wanted to leave the hospital, saying, “Let’s get the baby and go now” several times. She asks about the baby, says she misses him and such. Mom seemed confused about how to deal with her questions and feelings, so we role played a little about how to address her worries and feelings while also honoring S’s feelings. I encouraged S to sit with her daughter and ask her what she remembered of the event… and then ask her if she had any questions and to answer them. I encouraged her to cry… with her daughter… and that if she was crying and her daughter wanted to know why, to be honest and tell her. Not to hide it in the pillow. Her daughter saw a pair of scissors and asked if that is how daddy cut the cord… S didn’t know what to say because EMS cut the cord. I told her that would be a great way to jump into the discussion… and it will happen more than once.

I reminded her that her daughter doesn’t have the emotional or linear ability that adults do to put things in context. That her thoughts and worries will jump out like firecrackers, sometimes at the most inopportune times, but that it is great that she trusts enough to speak out… and she needs to so she doesn’t eat it up and swallow it, trying to take care of mom and her feelings. “Don’t Feel” isn’t a good way to grow up.

We talked about self-care. She feels so empty. She isn’t pregnant or nursing and she is such a good mother! It’s what she does best in the world she said. I reminded her that it is time to mother her Self for awhile. That this is a moment of practice for when all her kids are grown and gone and she is still left with her Self.

I encouraged her to find something interactive to do with her daughter… pottery, or swimming, or something… not just driving her somewhere and dropping her off.

I encouraged finding space and time for dating her husband when she is ready.

She asked about having another baby… when? I said that physically she could probably conceive about 3 months postpartum, but that emotionally and spiritually, she should wait until she was ready for THIS baby to come… not as a replacement for her son who died. (She’d already told me she wanted to have another baby because she felt incomplete.) I told her how this was so not like when people have a dog die and go out and buy a new one to replace it. This is more spiritually important. That she cannot foist the wishes and dreams for her dead son onto the new spirit to be. She said she understood, but I suspect she will be pregnant sooner than later.

S has asked me and another midwife (a CNM) to attend her next birth… to keep our hands off, but be there if she needs us. When she spoke about no fear at this birth, I asked how she would feel next time. She said she wants to have no fear! I beamed with joy to hear her say that.

Then she also said that once the head is out, she will push with her soul even without a contraction. She didn’t care if she tore everything, she would push her baby out. I gently explained that it was important to allow the baby to do his rotation, too, but that if her instinct led her to push, then, by all means, do it!

I’m putting her in touch with my friend who was birthraped on the east coast. They have so much in common. I sent her home with her phone number. I am also going to find a group for her of parents who lost a baby during late pregnancy and birth and right after. She doesn’t know anyone. I want to also put her in touch with the other UC moms I know who lost babies.

Of course, I told her she could call me anytime… at any time… even just to cry and be heard.

I can’t even imagine her pain. She said she can’t either. She tried to quantify it… comparing it to moms who lost their babies in pregnancy or later. I told her there was no measure for sorrow… that each person has their own horror to tend to… and trying to wonder if someone feels worse than you is a waste of your healing energy.

I shared with her about how Judaism teaches that there is a full serious year of mourning. How our culture says, “take a week off” and then back to business. But that is so unrealistic. We talked about the Stages of Mourning… and how they overlap and superimpose on top of each other… over and over… for a long, long time. Not to set a time limit on her sadness… that that removes a level of stress to try and conform. (Like labor.)

She kept a blog for awhile, but felt there wasn’t the support she wanted on-line, so logged off in November 2004. She went back last week and emptied her emailbox to start over. She went and read her blog and wrote about how tired she was and how her body hurt already… complaining about the pregnancy and what it was doing to her body. A yoga friend of hers said to her, “You call that suffering? Imagine if you lost a baby! Now, that would be suffering.”

And that is how her blog ended.

So horribly prophetic.

I feel so honored to be a part of S’s process. I feel compelled to tell the midwives around me – ALL around me around the world – why she chose to UC. Is that using her sorrow to press my agenda? Probably. Is that okay? I’m not sure yet.

I don’t want to say that all women who UC have problems because, for goodness sake, most have beautiful births! But, can’t I use her birthrape (her word, without my prompting) and the other birthrapes out there as an impetus for change because women continue choosing UC because of their previous experiences?

I’m so confused. And so, so sad for her.

I’m glad I could hold her for a moment.

Aimee's Birth (Part II)

2005-04-10T21:09:00.000-07:00

For those just beginning this story here, Part I is right below this.

As I stepped out of the car, umbilical cord dangling with a forceps connected to the end, I plopped down into the wheelchair and heard applause. Looking up, I saw a man on a balcony across the parking lot and he was hooting and clapping. "What was it?!" The nurse and I in unison - "a girl!" Woo hoo!! I started laughing at the absurdity of having a baby in the car. I had no concept of the mileage it would have over the years. I teach my students and clients that if they have a baby in the car to not be worried at all... that it is the coolest birth story forever.

The teeny nurse started pushing the wheelchair towards the ramp that led to L&D, but right off the street/asphalt part, before the ramp, there is a 1/4 inch step-up and the chick hit it... hard. I was knocked out of the wheelchair and stood there laughing, umbilical cord tick tocking between my legs, the clamp brushing my calf. I told her I could walk up the ramp perfectly fine, but she insisted I sit, so I did. I couldn't wait to see this.

As she pushed me up the ramp, she was nearly horizontal. I just laughed at the situation and swear she put oxygen on her face when she dumped me into L&D's hands.

I was wheeled through L&D, past the Newborn Nursery where Aimee was in the warmer and right into the Delivery Room. I hollered for them to bring me Aimee as I flew past the Nursery and they said she would meet me in Recovery.

Spouse tells me that when he went into the Nursery (he went in when the gang left me in the car - per my instructions), they grabbed my birth plan and the Nursery staff stood next to her in the warmer, ticking off what they were not to do. Bath? Nope. Erythromycin? Nope. Vit K? Later. etc. They were lost. And I loved hearing that.

In the Delivery Room (and for those confused about all these separate rooms, it was like that - a separate place to labor, usually a room for two women, separated by a curtain; a Delivery Room that doubled as an OR; a Recovery Room where women spent about 2 hours postpartum... until they peed, usually; and then the Postpartum floor where they stayed 3-4 days for a vaginal birth and 6-8 days for a cesarean), I sat alone in the wheelchair. I felt the placenta let go and started a great contraction. I hollered that the placenta was coming. No one heard but the echoing walls of the DR. I stood up and out plopped the placenta, right into the seat of the wheelchair. I stood there and yelled, "Placenta's here!" and Mark came running back in saying something about, "Can't I please give you a shot of pitocin?" blah blah "precip" blah and I said, "Nope" and reached under my dress and did some self-nipple stimulation. I barely had any bleeding. I didn't think to tell him that I'd been in labor for quite some time, I just didn't come in. I did not precip.

Mary Carol, my CNM, had said she would come in for me even if I had the baby not on her shift. However, when I delivered in the car and they called her, she laughed and said she'd see me in 3 days instead.

I was put into yet another wheelchair and moved to the Recovery Room and met spouse who had Aimee in his arms. I jumped into bed and touched my daughter for the first time on the outside. An overhead warmer was put over both of us and we were toasty within moments. I don't see these warmers anymore, either. All I see are the warmers attached to the isolettes in birthing rooms. Those overhead warmers were the best for keeping moms and babes together when a baby was slightly chilled or having some breathing issues.

I unwrapped her to look at her. My friend Kathy got there and we told her the story, laughing the whole time. Aimee had a brown spot on her left knee and I asked the nurse if it was a birthmark. She asked me what I thought it was... and I said, "I dunno, dirt?" and she laughed asking if I dropped her on the ground out there. Nope. Beautiful brow birthmark she carries on her upper knee to this day. I never see it without thinking of her amazing birth.

We nursed great and things were so fabulous, the neonatologist on said we could go after 4 hours postpartum. Then he came in at 3 hours and said that if she got the Vit K, we could go. Do it!

I was home 3 hours and 10 minutes after leaving.

Spouse went and got the kids while I called Heide, the German midwife, who came rushing over. When the kids were there, Heide checked Aimee from head to toe and chided me for not calling her when I was about to deliver. Confused, I said, "I thought you couldn't keep me as a client?!" and she said if I'd have called, she would have come. Dang.

So many other things to share. I had a really hard time nursing Aimee; she sucked on her lower lip and it wasn't discovered for over 2 weeks. I tandem nursed and that was really difficult for me, but I made it.

Besides the beauty of having another child, when Aimee was 2 days old, I went to a La Leche League meeting and met Sarah, the love of my life. Sarah'd heard about my cool birth, my fabulous birth plan, and came to the LLL meeting especially to meet me. It was there I met another woman who watched Aimee be born and told me the story from the inside of the hospital. I loved being able to have the story from several locations! I was with my baby girl.

I still laugh... am smiling writing this... it was such a great story to live. And even more fun to tell!

Aimee's Birth Story

2005-04-10T14:22:00.000-07:00

I was nursing Meggie and hadn't had a period since her conception. I had a feeling I was pregnant, but test after test showed I was not. I went to see a German midwife and her bimanual exam couldn't find a baby either, so I went to the military docs. I saw the black male doc that I despised; he was evil to women in birth and I suspected really hated fat white women. He did a bimanual exam, too, and found nothing, but, at my insistance, ordered an ultrasound. The ultrasound a week later didn't find anything either.

I was stumped.

I began feeling movements, but with Irritable Bowel Syndrome anyway, those movements might just have been gas rumbling around. You'd think that with this being my third time I might know better, but I was just as lost as the first time. Perhaps more so.

One morning, I was lying in bed nursing Meghann. And dang nursing hurt! I kept thinking, for months, that I had thrush, but her mouth was clear. My nipples just hurt like crap. My LLL leader friends questioned invisible thrush or invisible pregnancies - perhaps I was delusional? Wouldn't be unheard of.

So, lying in bed, I watched my intestines rumble so good I could see a leg sweep across my very fat belly. I poked at my then-husband to show him my non-pregnancy in action. I told him, over and over, I was pregnant, but he didn't buy it since all the tests and ultrasound and docs and midwives disputed it. I was never more sure. I told him if that wasn't a baby, he best just schedule a surgery to remove an alien dancing tumor or something.

That day I went to the PX and bought another pregnancy test and I held my pee the whole time. Lo and behold, the line jumped POSITIVE that time.

My wonderful midwife, Mary Carol Akers (where is she?!) ordered an ultrasound and they found a baby 20 weeks along. Where had it been hiding before?! Probably behind my fat. By my calculations of intuition and fetal movement, I was only 16 weeks or so and told Mary Carol I was not going to be induced if they thought I was late; that I knew s/he wasn't going to come for another few weeks. She laughed and said we would deal with that if the time came to discuss it. It didn't. The ultrasound was pretty right on.

My "due date" by that late u/s was April 18. She was born April 20.

However, an unexpected "complication" occurred as my membranes ruptures on April 13.

I was going to have another homebirth (Meggie was a UC at home), but with a midwife this time. I'd found a German hebamme (midwife) and I liked her lots! Heide Korner (with the double dots over the O in her last name) was the teeniest of women. She'd had two cesareans herself, but had caught over 500 babies at home, over 1500 in hospitals. She was a delight with her heavy German accent and not all the American words needed. We were still pretty darn poor, but paid her what she asked for because we so wanted a homebirth without the drama of EMS and CPS like we'd had with Meggie's birth.

When my water broke - and it broke with a huge gush and kept dripping - I called Heide (High-duh) and she came over agreeing that it was, indeed, my water. I knew that. I had no contractions at all, so after about 12 hours, I started doing all the aggressive things we know to do to invoke contractions. I was already nursing a 23 month old, couldn't have intercourse, have a hard enough masturbating not pregnant, so orgasm was out of the question... castor oil was the next line of defense. Ick.

Many years later, I learned to do castor oil shakes. Two big spoonfuls of frozen orange juice, a scoop of vanilla ice cream, and 2-4 ounces of castor oil (depending on the urgency necessary)... blended in the blender and glugged like nobody's business before it separates again.

But then, before labor with Aimee, I mixed it with orange juice... shaken. By the time the shaking stopped, it was already totally un-mixed and vile. There are not many more vile tastes in the world than castor oil. Hard to believe our grandparents/great-grandparents had to take a spoonful of it every day. blech

I shoved the concoction down my throat as fast as I could and tried, for at least 30 minutes, not to vomit. I never did get diarrhea.

No contractions 4 hours later meant that I had to do the mixed drink again.

And some people do add a shot of vodka/tequila/rum in their orange juice/ice cream mixture. I didn't.

I drank it again and really thought I was going to be ill that time, but I kept it down. I probably should have puked. It might have helped. I still didn't get diarrhea that is the hallmark of castor oil. You'd think 8 ounces would have done something, right?

At 36 hours, my hebamme couldn't keep me as a client anymore. I was devastated. That meant I had to have a baby in the hospital - again.

I called Mary Carol the next day and she said to come in at 72 hours ROM and we will consider an induction. I cried and began writing a birth plan.

Of course, I was taking my temperature every 4-6 hours, nothing in the vagina, wiping front to back (which is really hard for a fat chick), and taking Vitamin C... and staying home. It was hard not going out, to the park, to the PX, seeing my LLL friends, but I did what I knew I should do.

My membranes had ruptured on Sunday morning. Wednesday morning, I went to the hospital where one of the other CNMs met me and hooked me up to the monitors. The baby sounded great. I had assembled my cadre of spouse, girlfriend Pam who lived 2 hours away in Bad Kruznach, and another LLL leader friend (who abandoned me once I came out as a lesbian) and we all were stuffed into the tiny triage room where I laughed and laughed and laughed, making the monitor jump around noisily, sending a nurse in every few minutes to re-position the belts looking for my bouncing baby... jiggling baby, is more like it. I sobered as long as I could while they re-positioned things and then, as soon as she would walk out, we broke into hysterics once again. I can't remember what was so funny, but can guess it had something to do with a baby coming soon and my not even being in labor yet.

After they had enough of a strip, the CNM came in to do a vaginal exam. I bristled. As she did the exam, she had the strip of Ph paper in her hand to check for amniotic fluid. She also had a long q-tip to collect some fluid to put under the microscope to check for ferning.

The Ph paper came up negative.

Huh?

Puzzled, she inserted a sterile speculum and rubbed the swab into my very soft, but closed cervix. After waiting for it to dry on the slide, she wandered over to the microscope. Peering in, squinting, and then lifting her head, she looked back down and then at me. "It's negative," she said.

What?! Negative?

No amniotic fluid could be found.

Am I sure it had broken? Yes.
Did I keep leaking? Yes.
When did the leaking stop? I dunno. I thought I was still leaking.

Mary Carol called and talked to the CNM on and said to let me go home and wait for labor to start. I was ecstatic!!!!

The CNM tucked a doppler into my hands as she shooed me out the door to go home and wait until labor began on its own. I was stunned.

I went home and started on yet another birth plan.

I composed a birth plan for L&D, another for the Newborn Nursery, one for Recovery, and yet another for the Postpartum floor. With Mary Carol's help, I arranged meetings with the head nurses of each department and scheduled an appointment with the neonatologist as well. I was to meet them all on Friday.

No labor still by Friday, so I headed into the hospital for a full day of discussions with head nurses and a doc. Fine, fine, fine, they all said, when I spoke about minimal interventions, freedom of movement, wearing my own clothes... all those things that were incredibly daring to ask for at the time.

The meeting with the neonatologist was some different. Armed with my list, we spoke, for over 2 hours, going point by point, about what I wanted or didn't want. Discussing such things as dextrostix, bili sticks, baths, eye ointment, Vitamin K, early discharge (I was shooting for 6 hours postpartum... 48 hours was early discharge during that time), and breastfeeding continuously (unheard of at that time). The doc was amazingly cool about everything. He signed off on every single want of mine, even lowering the early discharge from 6 hours to "4-6 hours!" The only sticking point was the Vitamin K shot. After discussion, I acquiesced and accepted the shot, but we negotiated getting it right before I walked out of the hospital. No problem! He'd allowed for no bath, early discharge, no erythromycin, getting the baby in the recovery room and everything. I could live with the Vit K shot.

The head nurse of the Newborn Nursery typed up the agreements, the doc signed, I signed, and the nurse signed. I still have that original to this day. I was very proud of what I negotiated.

Labor began quietly on Sunday morning, while it was still dark. 7 days after my membranes ruptured. I slipped out of bed and went to labor/lie down/rock in one of the 13 bedrooms the
"bowling alley" housed. (The bowling alley is the top floor of military housing... the 4th floor... all bedrooms, lined up down a hallway. Freezing the further down the hall one went.)

I remember the dark of the room. My husband checked on me periodically, but pretty much tended to 3.5 year old Tristan and 23 month old Meghann so I could labor. I felt good. Ready. I would lie down sometimes, but found myself sitting and rocking again during a contraction.

My labor with Meggie had been 39 hours long starting when contractions had gotten down to 5 minutes apart. 2 hours of pushing.

This time, there was no time. I just rocked, alone, in the dark.

At 12:15pm, spouse came in to say that Meggie really needed a nap and could I please nurse her. I dreaded it. Her nursing was the reason I had slipped into one of the other rooms earlier in the day. She made contractions come on hard. After a week of trying so hard to get labor going, once it got going, it got going fast and hard with suckling.

I took Meghann reluctantly into our bed (we all slept together) and laid down to nurse her inbetween contractions. She latched on and I had a GIANT contraction that ruptured my membranes... again! Here we go, I thought.

I stepped out of the room, leaning on the doorjam and told my spouse that it was time to go. He said he had to take the kids to the sitter, so gathered them together and whisked them off to our friend's apartment in the housing complex a mile away. While he was gone, I called my friend Pam in Bad Kruznach and told her I hoped she'd make it. I called Kathy and gave her directions again to the hospital (she'd lost them). During the direction-giving, she kept saying, "Are you pushing?" "You aren't going to have that baby alone, are you?" and I just plowed on with directions.

When I hung up, my husband walked in, all casual-like and I told him it was time to go. He looked at me... I was leaning over the military-issued brown squared chair, contracting hard, sweating like a banshee in my blue dress... he looked at me and said I had better get control or they were going to give me drugs. He barely knew I had been in labor, but I really had only been in labor at all for 7.5 hours. He really thought I had a long, long way to go.

He went into the kitchen and started cleaning the rice and beans he'd made for lunch. It was about 12:50pm. I told him I really thought it was time to go and when he blew me off again, I left without him. I screamed at him as I slammed the door and headed down the stairs. I don't know where I thought I was going and I probably should have stayed put, but I was going to go, with or without him.

He followed once he realized I was serious.

Going down the stairs, I had 2 contractions every half flight. I was crankin'!

Outside was heaven! I was sweating so profusely, I couldn't get cold enough. It was April 20 and 40 degrees outside.

Spouse opened the car door for me. We had a two-door red Toyota Tercel, 1982. I got in, sitting, and he went to the other side. A contraction hit and I jumped out of the car. Spouse jumped out to come and stand with me. DON'T TOUCH ME!! Contraction ended, I got back in, this time on my knees facing frontwards. Spouse got back in the driver's seat. A contraction came and I jumped back out again. Spouse jumped out, stood next to me and I hollered for him to lower my seat's back as the contraction began to fade. Once the contraction was gone (sort of), I got in on hands and knees, the back of the seat at a 45 degree angle, me hanging over it. Spouse jumped fast into the car, closed the door and headed off.

Now, he caught on that I was pushing. He began chiding me to stop pushing. Blow! Blow! Blow! Blowing wasn't doing anything but allowing me to push with lots of hot air.

Driving the 7 minutes or so to the hospital, it seemed like forever. Contractions sped through my body a lot faster than the Toyota went through the Frankfurt streets. Thankfully, it was a Sunday, so minimal traffic, but it wasn't as fast as I wanted/needed it to be. I remember looking up and thinking, "We are only this far?" Several times.

Frankfurt in 1986 was a volatile time. Bombs exploded around the city off and on. Right before Aimee was born, an entire section of where our PX compound was had been blown to bits, the used car lot, part of the Burger King... it sucked, but it was a part of our day-to-day existence. Much like it is now, actually.

Because of the bombings and high alert status, the extended inspections were going on. Normal inspections included long handled mirrors being run under cars and trucks, opening the trunks and hoods of cars, and asking driver and passengers to please step out for a visual inspection. The extended inspection included running dogs through to sniff for bombs.

Our hospital (which doesn't exist anymore) was less than 3 miles from the PX area, so had barriers entering and at least two MPs on at any given time, and they were running the dogs through cars. Even on April 20.

I was full-on pushing as we pulled to the guard shack in front of the Army hospital and as the guard asked for our IDs, I gave the most gigantic push possible so they got it that a baby was coming out my vagina. The guard wavered, but finally said, "Go! go!" and waved spouse through.

Pulling around the left of the hospital, he stopped at the foot of Labor and Delivery. Jumping out of the car, he ran and opened my door so I could get out. I yelled that I couldn't move, to go get someone fast. As he started off, I told him to check and see if the baby was there. He lifted my aqua dress and said, "nope" and I said, "Go!"

Working at the hospital as a doula (before the word doula existed in our lingo), I knew their pet peeves. One was the doorbell. The nurses and doctors hated when someone would come through the double doors without being invited in after announcing their presence with the doorbell.

As spouse was running up the long ramp to L&D, I screamed, "Ring the doorbell!"

And then I was alone. With my baby. I was kind of upright, kind of leaning over the seat and I felt another contraction coming on. I was the most present I had ever been with any of my labors in that one moment... in those 60 seconds where I was alone. Earlier in the day, I was pretty present, but I was also worried about noises with the other kids around and stuff. This moment, there was no worry. Just peace. Me and the baby. Just me and the baby.

I felt her drop into my vagina. From uterus into vagina. It was incredible. 19 years later, I can still feel that feeling. As if it were a minute ago. I know I smiled.

And then chaos ensued.

A nurse came running down with my spouse, she pushing a wheelchair. "Get in! Can you get in?" she implored. I calmly said, "the baby's here" and the nurse lifted my dress and saw her head. "Shit!" she hollered and told someone to go get the precip pack. I learned later that the nurse was a CNM who hadn't gotten her paperwork to deliver yet at this hospital. So, when they ran in for the precip pack, they also called for the doctor.

I learned 2 days later that the women in the day room were watching the scene unfold. They could see out the window at the car, hear the nurses hollering for a doctor, and all plastered their faces against the glass to watch me birth my baby. Dr. Mark Repka clomped clomped clomped down the hall (wearing Birkenstock clogs as all docs back then did) and dashed through L&D, down the ramp and to our car. I knew Mark from working as a doula. He was one of the kindest docs in the mix and was glad, later, that I had him. At the time, however, I didn't care a whit.

Mark hovered outside the car, me still on my knees in the car, and Aimee barrelling out. He implored me to get down onto my side and I balked. He said, "she can't come out this way!" and that was enough to get me to flop over onto my right side, face into the back of the driver's seat. I suppose in skinny women, babies can come out with moms on their knees in a bucket seat, but for a nearly 300 pound woman, the doc was actually right. Thighs and ass, all in the way.

The emergency brake jammed into my right side and I was suffocating from not being able to breathe, my face crammed into the plastic car seat. Over and over I said I couldn't breathe, but all the activity was down at my bottom end, so no one heard me. In a momentary lull, I said it again and Mark sent spouse around the car to lower the car's front seat back. As he did, I inhaled deeply, felt Aimee coming, and spouse grabbed the camera sitting in the back seat.

Mark said to the CNM, "scissors" and I yelled, "No episiotomy! No episiotomy!" and Mark said, "Mrs. (last name), you are in the car, we are not going to do an episiotomy." Aimee oozed out of my vagina easily. Her sister had been 10 pounds 6 ounces at 20 inches long... a nasty shoulder dystocia. This baby, a girl, weighed 8 pounds 13.5 ounces and was 21 inches long. Her older sister had paved the way.

Mark said, "scissors" again and I yelled, "No episiotomy! No episiotomy!" and he laughed, along with the others and said, "Mrs. (last name), the baby is born, I am not cutting an episiotomy. I'm cutting the cord."

Because it was cold, cold! they cut the cord zippity doo dah and whisked Aimee into the hospital.

The entourage followed.

I was left alone with one nurse's aid and a wheelchair.

I need to break for a sec... lemme put this up and then continue later. My fingers are tired!

A Story

2005-04-10T09:42:00.000-07:00

A woman 20 weeks pregnant feels she is going into labor. She'd already lost twins at 23 weeks and another baby at 20 weeks, so she has a pretty good idea of what she is talking about.

In the hospital, they explain she really needs to consider cerclage... where the cervix is sewn shut until the end of pregnancy. She agrees. She is 2cm dilated already.

During the stitching, her membranes are accidently ruptured.

She is now hospitalized, ass end up (Trendelenberg position) with monitors on as she waits another 20 weeks for her baby's birth. She doesn't move except slightly side to side. No bathroom privileges. No trips to Babies R Us for receiving blankets. No La Leche League meetings or childbirth classes. Just lying, ass end up in a hospital bed, waiting.

The hospital doesn't have an exquisite NICU, so through consultation, it was decided to wait until the woman was 24 weeks along and send her to the Big University Hospital (BUH) where they could take better care of the baby should he be born early.

During the weeks, a guess is made that the membranes have re-sealed, however her amniotic fluid volume remains terribly low... between 2 and 4. Normal would be 18.

The extremely difficult 4 weeks go by and the woman, via ambulance, ass end up, is shipped to the BUH.

At the BUH, the doctor admits her and says she doesn't need to remain ass end up anymore. That there is no research showing that Trendelenburg does anything for women trying to keep a baby inside... that there is pressure anyway, so she might as well get up and do something. She refuses. She asks to see another doc who says the same as the first. She asks for another. Same answer. She goes through this 6 times, including with perinatologists, who tell her it is fine to get up.

She doesn't believe so, but she guesses they must know what they are talking about.

The nurse gives her a sleeping pill for her agitation and sends the woman to the bathroom to pee before bed. It is the woman's first upright in over 4 weeks.

She climbs back into the bed and the nurse attaches the monitors back on and wishes the mom a good night.

About 30 minutes later, the nurse wanders in and says the baby must have moved because they haven't heard the baby in about 20 minutes.

She can't find the baby, so they bring in an ultrasound machine. The baby's heart has stopped.

A vaginal exam shows an occult cord prolapse through the 2.5 cm open cervix.

This happened here, to one of my midwife's clients, last week.

The mom that lost her baby is a lawyer.

My First Cesarean

2005-03-03T10:08:00.000-08:00

Frankfurt, Germany - mid-late 1986

A woman found me via LLL (I was a leader back then) and asked me to be her labor assistant (no such word as "doula" back then). She was, after research, going to deliver in a German birth center. She did not, under any circumstances, want to have her baby in the military hospital (Frankfurt Army Regional Medical Center [FARMC] - it no longer exists). I don't remember if we talked about the what-if's... I know that I do now - but I remember being extremely excited about doing a birth out of a hospital in a foreign country.

We toured the birth center and met the midwives, who spoke minimal English. I loved the space. The rooms were so pretty - a garden yard could be accessed through the back doors of each room - and we moved through the space "seeing" my client in labor and knowing how great it was all going to be.

Labor time came and I met them at the birth center... mom was 6 cm dilated. (Isn't it amazing I can remember all these details? I had journals, but in a huff, my former husband threw them all out. My remembering birth details is in lieu of remembering songs - songs are lost in my head; birth details are retained forever!) Labor progressed really beautifully and mom spent a lot of time in the big bath they had in the room. It was cold outside, rainy, as usual, but warm inside and the steam from the warm bath made everything damp and soft.

Minimal vaginal exams were done, but mom asked for another several hours after one exam showed she was 8cm. When the midwife said she was still 8cm, the mom began to cry. As the midwife remained inside the mom, looking up at the ceiling (as midwives tend to do to be able to "see" with their fingers), I could tell she felt something besides the cervix and the baby's head. When she removed her hand, she began telling my couple, in her broken English, that she felt the baby's face presenting, which could hinder the cervical dilation. Through the years, I have studied face presentations and all-to-often, face presentations don't allow for enough pressure to dilate the cervix effectively. If given lots of time, it can happen, of course, but not everyone wants to wait that long.

And, the baby's head has to be in a posterior position to delivery vaginally, complicating the pain aspect of the woman's longer labor. If the baby is anterior, the neck cannot move that way through the pelvis without extensive damage. (For midwives and midwifery students, the mentum/chin needs to be anterior, which makes the head posterior - I've played with a lot of dolls and pelvises to be able to visualize this one. Researching, it is harder to find where the head needs to be since the usual discussion is regarding the mentum, not the cephalic presentation itself.)

The midwife said she wanted a second opinion from the doctor and when he came downstairs and examined mom, he said he could only feel an eyebrow, not a nose or eyes as the midwife said she could. He told mom she was fine and could keep going, even though she had been at 8cm for at least 6 hours with fabulously strong contractions.

When he left the room, the midwife sat there with a funny look on her face. My client was laboring, but I said to the midwife, "what do you think?" and she said, "I feel a complete face." My wonderfully strong laboring mom asked me who I believed. I said, without hesitation, "the midwife" because I knew that she had felt FAR more normal presentations than the doc and that if something was different, she would totally know. Mom asked for another exam before we began discussing alternatives and the midwife said she could clearly make out the mouth, nose, and one eye. Discussion began.

We talked about options. Augmentation with pitocin and cesarean were the two options we didn't have at our disposal at the center. Mom cried a lot during the talk, but she was an active part of the decision making.

As much as she did not want to go to the military hospital, she REALLY did not want to go to a krankenhaus, a German hospital. Not knowing if someone was going to speak English, knowing that a mediolateral episiotomy was SOP, that general anesthesia was SOP for cesareans... those options seemed worse than dealing with the military shit she had tried so hard to avoid.

I had been working at FARMC as a labor assistant for about 9 months by then. The nurses and docs all let me in - some tolerating me, others welcoming me - and I knew them all and knew most of their styles and personalities. During my time at FARMC, L&D was in two different parts of the hospital due to reconstruction. I had my baby when the hospital was on the lower portion of the hospital, right at the ramp to the parking lot. When Sarah had her baby, Aimee (my car baby) was 3 months old. The maternal death I witnessed was when L&D was up on another floor. In remembering, I thought that happened in 1986, but it might have happened in early 1987, but most likely late 1986. I wish there was someone around to ask so I could piece the time together. I know this is pretty irrelevant to readers, but for me, it helps me put the time frame together. When remembering being a doula back then, the births are distinctly divided between floors. It's good for me to write that down.

When it became apparent that a transfer would be needed, I called FARMC to find out who was on and to give them report. Blessedly, blessedly, the doc that was on was my favorite... very loving and kind... just the kindest doc at the hospital (the doc that caught Aimee and did my abdominal surgery was my second fave - fave for surgery, but not for birth). The head nurse was my favorite nurse Sally who was pregnant with twins and, years later, she became a CNM in the deep south (USA). When I was able to reassure my client of the kindness that would meet her, it made the transition so much easier. On the phone, Sally said it would depend on what was going on, but that an automatic cesarean wasn't what they would do. That also helped.

We drove our own cars to the hospital and the move into the labor room was typical with the changing of the clothes, the bracelet, the IV, etc. All stuff mom didn't want, but knew she would be getting simply by stepping inside their doors. Once the doc came in and examined her - she was still 8cm and it had been at least another 4 hours since the first 8cm observation - he said the baby was posterior, the ideal position for a face presentation birth. He said he had done face births and didn't have a problem at all with her continuing. Mom was relieved! He offered pain meds; mom declined. He offered pitocin; mom declined.

She labored for 4 hours and had another VE. 8cm. The doc said that he really thought she would need some pit to put enough pressure down on that cervix to get it open enough. Mom declined, but also said she couldn't do any more. She'd been 8cm, with 8cm-type contractions, for about 14 hours.

Discussion of a cesarean began. No one was harried. No one was mean. Everything was explained quietly and respectfully and mom, even as she cried, she was able to verbalize her desires for remaining close to her baby, staying awake, nursing soon, etc. The hospital said they would do their absolute best to adhere to her wishes. I believed them.

I hadn't ever been to a cesarean birth before. While I was disappointed for my mama, and damn tired from standing for so long (I weighed about 280 at the time), and am sure my boobs were going to explode from not nursing for so long, I was also excited to get into an OR. Oh, yeah, they were letting me in!

Sally asked me if I knew how to behave in an OR... would I get sick? I said I would not get sick, yes, I knew not to touch anything, to stay out of the way, etc. In reality, I knew nothing. laughing

Dad was in the room with mom as she answered a thousand pre-op questions. She'd asked me to stay to help with contractions, so I was privy to some information I hadn't known about. When mom was asked about how many times she had been pregnant, she said 3. Live children? none. Spontaneous Abortions? None. Therapeudic Abortions? Two. I didn't think anything of it, because that's how I am.

Mom was taken back to the OR to get the epidural before dad and I were brought in.

I was given scrubs and had to ask for bigger ones three times. I ended up in XXL men's gowns (one forward/one backward), only undies underneath (I didn't know to keep my clothes on back then). I put on the shoe covers and the head covering thingie. And I waited with my camera.

I was in the labor room waiting with dad and he was really quiet. I asked, in my labor assisting way, if he was okay... that this was quite different than they had planned for. And he looked up and said, "she never told me about the abortions." Oh, my. I gently said that he might wait a few weeks to talk about that, how hard that must of been for her to share in public and in front of you and she was birthing his baby in a few minutes... and I hugged him, letting him know it must have been hard information to hear.

This taught me to let women know, at any time I have a second of a private moment with them, that if they have stuff to share that their family doesn't know about, to ask everyone to leave and only speak with the nurse alone. I also, in interviews, tell them that if they ever want to speak without me in the room, too, just say it! I take no offense whatsoever.

As I was putting my OR suit on, I made sure my hair still looked good. I had a perm at the time and I floofed my air as a halo around the edges of the elastic paper cap. I looked good.

We were escorted to the OR where mom was already splayed out cesarean-style and Sally walked up to me and grabbed my head thingie and shoved my hair under the cap totally. I'm sure I gave a little whine and she stood back and glared at me: this is surgery, not a beauty pageant. I clamped my whine shut. I knew I would have bad hat head, but pushed it out of my mind.

I'd never had a mask on before. I remember that I felt lightheaded the first dozen or so times I wore one until someone explained to me to JUST BREATHE NORMALLY! What a concept, eh? I don't quite know how I was breathing, but it wasn't normally. Plus, the way I was breathing, my glasses kept getting fogged up. Years later, someone showed me the trick of pinching off the nose clip so the air doesn't zoom up to the glasses. For this birth, however, I was breathing funny, felt lightheaded, had foggy glasses, and worrying about my hat head.

Dad was plopped down on the head stool, but I was allowed to wander around the OR to take pics. (Something that would never be allowed nowadays.) As her belly was being opened, I smelled that burning flesh odor I'd never smelled before - and immediately thought of the smell of the Holocaust, feeling all light-headed again. I faked it, though, and forced myself to chill and Be in the room with my client.

I saw the uterus and it was so beautiful! I leaned forward to snap a picture and Sally, my OR shadow, snipped the cord of my camera right off the camera! I pulled back and looked at her confused-like and she looked at me (the only thing on her face that was visible were her eyes) and said, behind her mask that I was about to lean over onto the instrument table and my camera strap would have contaminated everything on there. I blushed.

Stepping over the now-dead-on-the-floor camera strap, I carefully took pictures as the cesarean unfolded. I became much more aware of my space and place in the small OR.

My client, awake and excited, yet crying at times, listened as her baby was born in a loving and respectful manner. I am eternally grateful that my first cesarean experience was so positive and gentle.

Her son, weighing 9 pounds 12 ounces, came out and for two weeks after birth, held his head as if he was watching angels near the ceiling; the back of his head touched his spine.

During mom's physical recovery, she thought lots. She wrote me the most beautiful card, many words shared, about how, in a place she'd dreaded spending time in, she'd found that she could trust even those she'd never trusted before. She said the lesson of putting your life, or the life of your child, into the hands of strangers and trusting them to care for you was the hardest thing she'd ever done. She said she learned a lot about trust and belief.

I learned, too, that women can have decent experiences in the hospital. Of course, over the years I have seen the worst of the worst and the best of the best, but, when medical care is needed, it CAN be decent. Should be, yes, that's a given. I have worked hard to know how to make it decent over these years. Most times I succeed. Sometimes, it is absolutely out of my control.

4 years later, mom was in the US in the northeast and had found a birth center to deliver in. She was strong in her desire for a VBAC and I knew she could do it. We talked during her labor, sometimes 2 hours at a time, and when she hung up the last time in her labor, she was pushing her baby out of her body. Her VBAC was a triumph for her! As VBAC is for all of us, even those of us who've never had a cesarean at all.

H2o HBAC!

2005-03-01T22:42:00.000-08:00

So, a woman called the midwife I work with most of all… the same midwife I took to the Hand's-Off birth several months ago… because her OB was telling her stupid stuff about wanting a VBAC, something he’d promised her the entire pregnancy. She was then 34 weeks along.

Her first birth was in Australia and for a variety of odd reasons, she was induced at 36 weeks along. When that failed, she had a cesarean.

This time, in the US, her hand-picked doc said, “oh, yeah! VBAC? No problem.” At 34 weeks, she brought her birth plan in and he rolled his eyes, trying to be somewhat discreet, but then went on to say things like, “your uterus might explode during pushing,” and, “we just don’t want to meet in a courtroom with you showing a picture of your dead baby.”

She left horrified and that is when she remembered her former childbirth educator turned midwife and called her. She came to see us the day after that appointment, but on the way to my office, she picked up her records.

In my office, we’d just had our conference committee meeting, so Tonya Jamois, the president of ICAN, another doula, the midwife and I were all available to share with her… and we did. The woman and her mom sat on the couch in my office and showed us her records. The last note said something like: Reviewed birth plan. Consider general anesthesia for repeat cesarean. She was stunned that he would put something like that… and she would never have known had she not gotten her records. She would have gone in for a VBAC, been railroaded into a cesarean, and had general anesthesia to boot.

Thank god she woke up.

So, at 35 weeks, she decides she is leaving the doc and choosing to have a homebirth… something she had not ever considered. Her husband needed one meeting with us and he was convinced.

Because her previous birth had come at 36 weeks, this full-term pregnancy was forever-long. She kept saying how she wanted to have the baby and we chuckled, telling her we would remind her of this moment in the throes of labor. And, as all women do, she went into labor… 40 weeks and one day.

I got the call to come over at about 7am and got there at 8:30 or so… damn that San Diego traffic.

Mom sang her heart out during contractions. Her sister was there, her husband, and the right-before-pre-school twins. The day was sunny… the first one in at least two weeks. A lovely morning, in a beautiful home overlooking hills and mountains in northern San Diego County.

The pool was filling up and mom moved around, waiting to climb into the water. Once she got in, she didn’t get out again. From side to side, to hands and knees, she felt SO much better in the pool than out. Her sister clung to the mom’s hands for awhile, but the kids needed attention and mom wanted hands to clutch; I became the clutcher.

Along the way, dad got into the pool with mom. He was so calm and loving and gentle. He was great.

The sister was interesting though. She’d had two hospital births and wasn’t quite sure where she needed to be or do. She massaged her sister hard, like she was getting her warm after she’d been in the snow for a day and a half. And at one point, her “relax, relax, relax, relax, relax, relax, etc.” needed calming, so I gently said, “please don’t use that word” and she stopped saying it.

Nearer the end of the labor, I needed to move from the hand-holding so I could ready stuff for the birth (it was all in the bedroom; we were in the living room) and sister took over again. I came close at one point and the sister grabbed my arm and looked me in the eye and said, “I’m scared” and I sat next to her for a second and told her how perfect everything was, how wonderful it was all going… and the moment she could, she excused herself from the handholding and asked me to take over.

I held mama’s hand as she puuuuuuushed. She never held her breath and wasn’t even sure she was in second stage.

She asked for a vaginal exam a couple of times, but her midwife was able to deflect. It was great! She would ask, “where do you think I am?” and her midwife would say, “where are you?” She would ask, “can you check me?” and her midwife would say, “you can feel… where is the baby?” and it always worked! The only time the midwife checked was after imploring (mom’s) and the baby was a knuckle inside the vagina; no cervical checks at all. Listening to fetal heart tones was very occasional.

We did our best to honor the marriage bond, the mother’s desires, and remain just under the radar. Unless asked.

So, mom is pushing… grunting with all her voice… and from above our heads, her sister says, “put your chin on your chest!” and I nearly busted out laughing. The midwife and I looked at each other and the midwife repeated that she was pushing exactly how she needed to, that the baby was advancing perfectly… and sister didn’t say anything else about how to push.

For days after the birth, I could hear those words – put your chin on your chest – and it made me laugh out loud, several times. It was hysterical and sad all at the same time, how indoctrinated every woman (almost) is in the American Way of Birth. Blessedly, there were enough of us around to counter the brainwashing. I wondered about my own gradual un-brainwashing… and its continual evolution.

Mom loudly sang her wonderful 9 pound baby girl out in the water over an intact perineum. Her uterus did not explode in second stage.

As the baby came out, they were giddy with joy. “I did it! I did it!!” and mom and dad, embracing their daughter, cried in words and tears.

Blood began oozing out into the clear water. The water began getting murkier and dad was a tad concerned, so mom stood up, stepped out of the pool and delivered the placenta into the bowl.

She walked to the toilet, dried off, and then climbed into the bed with her family and nursed her big ol’ girl for hours.

We did the three day home visit yesterday and talked and laughed and cried about the birth. The tears came from hormones and her observations of her Self during her birth. She spoke of her sheer joy that we never took her power, even when she offered it. That we were so respectful and careful to keep her in her power… how we encouraged her to believe in her own knowledge, to know that she could feel her own body. She spoke of her own pride, over and over, and that made the midwife and I so proud, so filled with joy that we, too, wept.

Mom told us we changed her life. Dad said he has now become a crusader for homebirth and has told everyone at the office they should consider it, how joyous it was. We told them both that they, too, affect our lives, that their joy, their power, their belief in their Truths, reminds us of what we are doing this for.

The most tender moment of yesterday came when she took my hand and looked at me and told me that one of her highlighted moments in her labor was when she needed help and opened her eyes and looked at my smile and my bright blue eyes and felt safe and could go on. It means so much to me that I can remind a woman of her perfection in those moments of challenge and, even sometimes, fear.

What a joy this birth was!

And her uterus, her vagina, her family, her nursing relationship, her psyche, and her spirit… all remain whole and intact.

A Series of FORTUNATE Events!

2004-12-26T08:58:00.000-08:00

Client came for childbirth class on Sunday and looked kinda funny.

Near the end of class, she asked me for a pad and I raised my eyebrows and asked why. She said she couldn't stop peeing and I asked if I could have some of her pee in her undies. She laughed (she is a joy-filled client) and I said perhaps she had ruptured her membranes. It was clear, so she wasn't sure, but it had started leaking at 2am (it was now 1pm the same day). I got my prenatal bag and nitrazine paper and checked and ayup, it was positive for amniotic fluid. She had no contractions. I did a sterile vaginal exam and she was 1-2/40%/-2. I was disappointed and concerned.

This client had also chosen to do a GBS test and was positive. She did the alternative regimen, but remained positive 2 weeks later and wanted antibiotics during labor because of this.

We were on a time limit.

I gave the client several options including the hospital induction route... cimicifuga and cauliphylum; castor oil; nipple stimulation; visualization; acupuncture. She was game for them... all but the hospital one.

On the way home, she called the acupuncturist who came to her home within an hour. She had begun the C&C in the office and was taking that every 4 hours. She knew to put nothing in the vagina and was taking her temperature every 4 hours, too. I was going to meet her at 7pm (18 hours post-rupture) to start IV antibiotics.

I got to the client's house at 7pm and loved her house! She had just moved in with her roomate... her man is in South America having just gotten his visa to come to the US. She was going to move to a local Indian Reservation to birth at her mom's (she wanted a teepee birth, but that didn't pan out; she is Native American), but knowing that there was a possibility of transferring to the hospital that was a few miles from her own home, she decided to stay home.

The CNM in the practice came and we had a long talk about what might come down the pike without labor even a hint. She tried to get a vein three times and missed. I was going to try next and then kept thinking: save something in case you go to L&D.

It was 9:30pm and her family was starting to assemble. We needed to make some decisions.

She had had 3 acupuncture treatments (was having her third at 9:30pm) and not a hint of contrations.

After discussions, she decided to move to the hospital. Never ever did we "see" this birth in the hospital. It was very odd.

So, we get to the hospital at midnight and she is admitted from Triage by 2:15am. She decided to fudge 12 hours off her real rupture of membranes time. She didn't come up with that idea on her own. We offered ideas of how to speak about her membranes and it worked. "I wasn't sure, but I thought I started leaking at 2 or so." and then I piped up and said, "and so I checked and she was positive!" They wrote 2pm instead of the true 2am. Her sterile VE showed 1-2 cm/40%/-2.

Once in L&D (we had a HUGE room), I finally sat with my leg up and the drama of admitting began. One nurse tried to start the IV twice and blew the veins the same as the CNM did at the house. Another nurse came in and didn't even feel and started the IV within seconds. I want her to start all my IVs!! The pit was started and the long night continued.

I went to the car to sleep at 3:30am. Her mom slept on the pull out chair thingie I had my leg up on. I awoke at 6am and went back in. Nothing happening. That is how it was all day. The pit was increased every 20-40 minutes and then by noon, she was at the max amount. A nurse took me aside at 8am and asked if I knew where this was going. I said that I did. The OR was what she meant. She said she would probably have the baby by noon.

Later, we were told the doc would be in around noon and a decision would be made. No vaginal exams until the doc. I told the client and her mom the doc wouldn't be there until 1:30. At 3pm, a new nurse (we had a bevy of nurses) came in and said the doc was held up at another hospital and gave orders to up the pitocin.

Very shortly after, the client began feeling the contractions and having to breathe through them. I was extremely tired and called my midwife-friend in to help me. I needed to sleep. She got there quickly, but by the time she got there, I didn't want to even go sleep in the car lest I miss something!

The doc got there at 5pm and did a vaginal exam. She was 2/80%/-1. It didn't look good. But, there was some change, so she wanted to wait awhile and see what happened. Maybe another hour. The nurse (and I) thought she heard some late decelerations and the doc ordered an intrauterine pressure catheter (IUPC) and the doc, 2 contractions after the last exam, put the IUPC in and commented that mom was now 3 cm. Woo hoo! Hope!

Nurses would say, "you know, she will be having this baby one way or another by midnight" and I believed them. I couldn't believe we had bought so much time so far!

With the IUPC in, the nurse became alarmed because for the first time they could SEE the contractions my client was experiencing. She is a master meditator and she was extremely peaceful and none of the nurses thought she was feeling a thing when she was, in fact, doing slight breathing for quite awhile. She didn't get "working-feeling" contractions until 3:30pm or so, though. When the nurse saw the contractions on the monitor, she stood and watched because my client did NOT have an epidural and was experiencing massive contractions. For those that know: the TOCO was nearly zero'd out... 3-5 being the baseline. When she had a contraction, it would go to 80-90 each time... some of them off the damn paper and higher! The other midwife and I were worried about the client's uterus! The alarmed nurse turned the pit down after about 3 minutes seeing the strip. She was having contractions every 45 - 60 seconds and while they were short, they were hard. She ended up turning the pit down 4 times before it settled where it did.

Now, the doc was supposed to come back after feeding her cats (after her 5pm visit), but she was called to the other hospital again and wasn't there. My client labored on. I took a nap from 6:30-8pm. I thought I was going to throw up I was so tired. I laid down in my car and shut my eyes and then the other midwife called me. 90 minutes had passed! I went back upstairs.

A vaginal exam at 9pm found my client 3/100%/-1. Change! A long discussion about getting an epidural or just asking for a cesarean began. The other midwife and I shared our thoughts and in the end the mom decided to let the doc make the choice (via phone). The doc voted for epidural because she was... you guessed it... at another hospital! Wheee!

The epidural went in at 10pm. Quick, easy, and comfortable. Mom went to sleep and the midwife and I went to eat. We were in the lobby yacking and heard a call to her room so we hightailed it over there. Apparently, at 10:30, she was 5cm and now, at 11:15pm, she was complete!

Mom felt some urge to push and pushed really well with the nurse's fingers inside showing her where to push. All those things she learned in class to not do were inacted. She laughed a lot about that happening. Even the exercises about working with pain so it doesn't overtake you... she had to focus and make the pain hurt or her contractions would peter out and go bye bye.

So, she is pushing and the nurse is readying the room, so I ask if I can sterile glove and help my client. Sure! she says. I glove up and work with the client about where to push. We get the client to put her hands in her vagina and feel the head and she does over and over. Joyous! Her face was filled with bliss (and we said as much several times). She was ecstatic that she was having a vaginal birth after being led all the entire day that a cesarean was where she was going. She was more than bliss-filled.

The doc was called and she got there, gowned and sat behind me watching. As she was gowning, I said to her to just let me know when she needed me to move, that I would jump off the bed the second she needed me to. I worked with the client until about 3 contractions from delivery and the other midwife shoo'd me away from her vagina. I asked her later why she didn't wait for the doc to say something and she said she was the kind of doc that wouldn't say anything and then be very angry afterwards. Oh. So, I trust my midwife-friend, so moved and they broke the bed and put her feet in the pedals inbetween contractions and the head came out and the baby was born and it was delicious and fabulous and wondrous all at once! We all wept with joy!

It is a boy and he is gorgous! A Native American mom and an Hispanic dad. Oh, how yummy he is. 8 pounds 10 ounces. Small tears that needed repair (I think from the doc's pulling on her vagina... I was very gentle and had no blood when I was in there), all inside.

The baby was doing great, but has had some transient tachypnea and they were especially freaking because of all the time with ruptured membranes and the GBS issue, but he is fine.

The baby did end up with ABO blood incompatibility and under the bililights for a couple of days. Mom just got home and told me the baby continues with some tachypnea at times. We'll watch that. They gave her a lot of education about GBS infection, so I won't have to harp on her or anything.

Because of the ABO incompatibility, this baby would have also been hospitalized after birth. His jaundice levels rose high and went high FAST (15 at about 30 hours postpartum) and while the bili experience was not as positive as my last client's (nursing in the bed, keeping the baby in the room under the lights, etc.), mom is coping well and has been out of the hospital for a day now (the baby is 6 days old now) and nursing is moving along beautifully!

What a cool story of hope for me. I am constantly surprised and amazed.

Forced Cesarean

2004-12-01T07:43:00.000-08:00

We drove 90 miles at 80 mph to get to the hospital that was supposed to treat us nicely... kindly. We passed at least 8 other hospitals along the way and left two, much closer, behind us. We had been led to believe that the university hospital, a hospital that also had a birth center on a separate floor run by over a dozen CNMs, would be a safe space for us midwives who had to transfer a client in the midst of labor and birth. Absolute emergencies, of course, went to the closest hospitals, but this wasn’t an emergency. Yet.

We drove in a caravan, me behind the laboring client whose husband was driving, the other midwife right behind me and then family members behind them. Thankfully, most of the evening traffic had abated, so the gang stayed pretty much together until we got a lot closer to the hospital downtown.

I kept begging God to let the baby come in the van. Please, please, please just let the baby come now.

When we left the house, mom was 7-8 cm and the baby was a –2 station. A huge difference from complete and 0 station before the hugely bulging membranes ruptured. Sometimes membranes not rupturing make me angry! They aren’t always misleading, but this time, those membranes told a whole different story than when they were gone and the head got to tell the story. At least the fluid was clear. I was so worried the fluids wouldn’t be clear once the membranes broke, but that was a pleasant surprise. It is one reason we don’t like breaking them; what we don’t know won’t scare us.

The other midwife and I paved the way for the client who was waiting for a wheelchair to bring her up. Does she want to try for a vaginal birth? Well, we doubt that will happen at this point, but, of course, if possible! The charge nurse tsk tsking in the background as she was assigned a bed.

Into the room the entourage goes and mom is hooked, hollering, up to the monitor and asked a dozen questions. Everything is going too fast! It isn’t an absolute emergency. A female resident comes in and says she wants to check my client and she submits to only the 4th exam of the labor. She has a cervical lip and the baby is +2. What?!? She is fractions of inches from having this baby vaginally! The doctor wants to see if she can lift the lip and has my client push with all her might as another nurse is prepping her for an IV and others are bustling about the room. She pushes as best as she can after not pushing for the entire 2 hour journey down to the hospital and into that bed and the doctor takes her hand out and says, “sorry, don’t think it’s going to happen.”

And that’s it.

And that’s it?!

My mind races as I think of alternatives to a cesarean for a cervical lip with a baby at a +2 station (+4 is the baby’s head visible at the entroitus). I mention to the doc that some midwives will use ice in a sterile glove on a swollen lip... might we try that? She said she wasn't comfortable with that, but interesting concept.

I discuss with the client... quietly... but quickly... that an epidural might do the trick. An hour or two without pushing/pressure might relieve the lip’s pressure and the baby could come sliding out. Positive, loving words of encouragement, her perfection, how great she worked all the way down from another county. I nurse starts the IV angrily in the back of her hand causing my client to holler and wince. The anesthesiologist is going to come in now, another nurse says, to discuss her spinal for the cesarean.

Somewhere in all of this is the absence of the CNM who was supposed to meet us in the room. She had an emergency transport from upstairs to L&D, so couldn't meet us. Had that happened, we might never had experienced the story below.

Later, another CNM told me that the new slew of residents and attendings hadn't been sufficiently brainwashed by the CNMs yet to leave things alone. They were eager to cut and learn. Why on my client?

I note a waif of a woman at the bottom of the bed staring, but say nothing to her as I discuss strategy with my client; there are so many people in the room already. The nurse walks out the door and I let her know that my client would really like to discuss an epidural so she might have her vaginal birth after cesarean and the curtain drops in a huff.

Waif woman, it turns out, has been eavesdropping and also happens to be the Attending Physician; the Queen of All Decision Making. The attending says she just doesn’t see how a vaginal birth is going to happen... mom has been through SO much already, isn’t it time to just have the baby in her arms now?

The anesthesiologist comes in and does his Spinal Spiel... checking for dentures, size of the mouth and throat, going over allergies, discussing previous surgeries... and the other midwife, gently, touches his shoulder to explain that mom had to be poked three times for her epidural last time. He shrugs her hand off as if she were a poisonous spider without any other acknowledgement of our presence.

Mom, in so much pain, enduring the indignities of these people’s questions, being poked, prodded, having the monitors adjusted over and over during contractions (they always forget that not everyone has epidurals and adjust them during contractions)... all she wants is a moment of relief.

She says to the anesthesiologist, a male doc, that she wants an epidural because she wants to try and have a vaginal birth. The attending butts her head in there and says she doesn’t think that is going to happen... and look! the baby is starting to show signs of stress now. Look at those late decels. What?! I go to the machine and see no late decels, but plenty of head compression decels and find hope in them... wanting to scream at the attending for her hate and venom of disbelief in my client and her ability to birth vaginally.

I write this in a linear fashion. This was not linear. This was layer over layer of fear and anger and waves of loud and huge contractions and disbelief and shock and noise and undermining and lying and people talking all at once and hurry! hurry! hurry!

My client asked for a few minutes with her family, leaving the other midwife and I with her husband as she said she really wanted to stop the pain and to try for a vaginal birth. I asked her if she wanted to see the strip because I didn’t believe they were late decels at all and she said she couldn’t look as yet another contraction pulled at her body.

The docs came back in... three now... the original resident, the attending and the anesthesiologist... and the CNM, too... and as my client asked for an epidural, the attending lowered the client’s bed some... pointing to the monitor showing what a hard time the baby was having now. There wasn’t time to see anymore. It was time to go back now!

The anesthesiologist began discussing the epidural and that it wouldn’t last long... maybe two hours... and it wouldn’t be able to be used for the actual surgery. She didn’t care! The attending had to have given him a glaring, evil look or kicked him under the bed or something because then he started this whole other voice.

A grapeseed of evil surrounded by a honeycomb.

Now, if you have an epidural in here, if we have to go back, I just might not be able to re-dose it. Sometimes it’s hard to do that.

Remember, there is a lot of commotion still going on... still so much noise and activity. But he created this tiny pocket of silence where only the client, the husband, the midwife, and I could hear.

So, if you can’t be re-dosed, then, gee, I guess you’ll just have to have general anesthesia for your surgery.

My head swirled. I thought I was going to vomit as his threat washed over me. I wanted to take the IV pole next to me and smash his arrogant head with it, letting him feel the agony he was causing other women at his hands.

There were no options. They evaporated with his remark. This man, no matter what, was going to have needles next to my client’s spinal cord and he had the power to make that experience hell or tolerable. My only regret is not begging my client, just one more time, to try without medication. It was ludicrous since she’d been in good active labor for about 50 hours at that point; it wouldn’t have been fair to do so, but since it is human nature to replay things a thousand times, that is my only major regret.

I wasn’t sure if my client “heard” what he said, but I leaned over and whispered to her, through tears, “you have to go back now” and she said, “okay.”

Promises were made about keeping mother and baby together, Duramorph being used so mom could be pain-free long, but still mobile, and mom was wheeled out of the room with the chaos, leaving dad, the other midwife, and me.

Dad was in the OR for the birth and remarked that someone had to go to the end of the table to dislodge the baby’s head from the pelvis before she could be born abdominally. Another wave of nausea swept over me.

Mom was taken across the hospital to the “overflow” recovery room... the PACU... where no babies are allowed, where moms are not allowed any visitors at all... where the recovery period is 4 hours as opposed to the 2 hour max in standard OB Recovery Rooms. The baby was taken to NICU and found, quickly, to have low glucose. (All this happened within the first hour postpartum.) The nurses wanted to give her a bottle of formula and when dad refused, they readied an IV solution of dextrose! An IV!! Through careful and kind negotiation, dad convinced an NICU nurse to take the baby to the PACU to nurse on mom and, blessedly, they did (after much arguing about policies). The baby’s glucose never went down again.

Mom was left alone in recovery despite my trying to get in. When we sent the baby, the mother-in-law (MIL), an NICU nurse herself, tried to stay, but the client said she wanted to sleep. The PACU nurse made snotty comments about mom sleeping so well until the family interrupted. I asked dad if he told the nurse to shove it and that mom would MUCH rather lose some sleep to nursing than sleep through the first 4 hours postpartum without nursing. He said he said something to that effect.

Mom's belly incision was made above the old incision... and in a drunken fashion. The resident's first incision on a belly? We are waiting for the records to see what the uterine incision will be... hopefully, the same incision, but, considering the surgical and emotional punishment foisted on her throughout her short L&D experience, I wouldn't doubt if they gave her a vertical incision on her uterus.

After the baby nursed, I gathered myself together, said my good-byes to the troups and went home. I’d gone to the mom’s home 23.5 hours earlier, fully anticipating a wondrous and amazing birth. And here I was going home, defeated. Feeling so useless as a midwife. Feeling powerless as a doula. Feeling useless even as a friend.

I sobbed the entire way home.

25 Hour Precipitous Delivery - Part 3

2004-11-13T17:41:00.000-08:00

Once we were all assembled in the hospital, things lightened up. The un-laboring mom was glad the doc was there. The grandmother was thrilled we were there. Dad, calm as always, was fine we were there. I was very disappointed, but also very relieved we were there considering the issues at hand. I asked one of the other midwives to come and give report before leaving, so she did and I was grateful. The other midwife left before we left for the hospital.

Our nurse was fantastic. She was kind, respectful, cheerful and wanted my client to have all the things she wanted even as her plans totally shifted from a homebirth.

An anesthesiologist came in to start the IV and had to poke twice before getting it into her antecubital (inner elbow)... (we were vindicated!)... a horrid place since she couldn't bend her arm at all. I asked for an arm board, but they had to order it from the pharmacy. It still hasn't come in 2 weeks later. Mom did her best to not bend the arm, but worried most about nursing.

Once the doc came in, he did a vaginal exam and found her to be about 5-6 cm. Continuing to progress without contractions, he was glad she was there, too. He asked if the pit had been started yet and the nurse laughed and said she was still getting everything together. The client asked if she could have some cranberry juice... said that was the only reason she agreed to come into the hospital... and the kind nurse said she didn't think that would be allowed. The doc, sitting in the rocking chair across the room, said, "she can have as much as she wants!" and the nurse quickly brought one of those pitchers filled with cranberry juice and ice! I expected those little half cup thingies; she did good.

Mom asked if she could get the IV out right after the birth and the doc mentioned her history of bleeding and that perhaps they will leave it in for awhile. The nurse said to the doc that usually the IV is left in until the woman has voided (peed) twice. The doc laughed as he looked up at the nurse and said, "so, you void once and I'll void once and then we'll take it out!" We all laughed. I thought that was indicative of the kindness of this doc.

As we did introductions, the doc got around to me and said, "I remember you," as he shook my hand and I repeated my name. And I had hair 2 years ago!

So, the pit was started and every 20 minutes it was moved up a degree. We ordered food, ate food, including mom inbetween the contractions she was beginning to have about 2 hours into the pit upping.

At one point, I looked at mom and told her that we had spent so much time on the preparations for her birth, I hadn't totally explored how to support her physically/emotionally during contractions. We'd assumed she wouldn't have any and here she was, having them now. She said she would let me know how I could help when it got to that time.

Time passes and our lovely nurse has to go home. We begged for a nice nurse... PLEASE find us THE nurse that is your twin... and she said she would do what she could. Apparently, she couldn't do much. We got a brusque and disrespectful-of-contractions nurse who apparently forgot my client didn't have an epidural. She tried to move the monitor belts during contractions, talked when it was inappropriate, and was just too fast zipping around the room. We gave her about 10 minutes before I told my client that I wasn't so thrilled with her. She said she wasn't either and we strategized about asking for another nurse when the phone rang. I picked it up and it was the nurse who'd just gotten off shift. Puzzled, I listened as she kinda whispered that we might really consider asking for another nurse. I couldn't believe what I was hearing!! Never, in all these years, has a nurse EVER called to say that about the nurse that followed.

I went to the nurse's station and let the nurse sitting there know we wanted to see the charge nurse and re-entered the client's room to hear the grandmother, a charge nurse herself, having a mini-fit about our asking for a new nurse.

Instead of getting a new nurse, labor zoomed into high gear and the client began shaking and sweating... her typical THE BABY IS COMING NOW signs, so she told the nurse to get the doctor. The nurse buzzed the nurse's head on the bed and then reconsidered, saying she needed to do an exam before calling the doctor... that she needed to make sure mom was complete. I told her I was sure she was complete, but the nurse told me to examine her or she would and I wasn't about to knowing the baby was probably right there!

The fuzzy nurse voice over the intercom said, "May I help you?" in that muffled microphone way of hospital's and the nurse said, "never mind" at the exact same time the client SCREAMED: GET THE DOCTOR IN HERE NOW!!!!!! Within seconds, the room filled with nurses who wanted to see what was going on and the mom screamed again to get the doctor because the baby was coming. The nurses left and our nurse was tsk tsking the client and then the nurse looked right at me and said, "glove." I stood looking at her thinking, "she wants me to open her gloves? she wants a glove?" and then she yelled, "glove up!"

Oh my god! She was going to have me catch?!? I washed fast and then gloved and told dad to glove and I grabbed a washcloth because mom blew her bottom out last time and we were going to work to go nice and slow this time. She had another contraction and the head began showing and then the doc walked in.

As he gloved, I removed mine and moved to the side of the bed, near mom's head. She was stirrup'd, draped, and then the baby, coming out without a contraction, continued progressing outward. The stupid nurse was to my left and was exhorting this mom to PUSH, PUSH, HOLD YOUR BREATH! And I glanced at her and wondered what the hell she was looking at when she seemed to be looking at the client's vagina. I whispered in mom's ear, "slow, slow, you don't need to push, the baby is coming nice and slow... good, good... that is perfect..." blah blah blah. It was all overlaid with the family exclaiming how much of the baby was showing and mom not pushing as the baby slid out.

I'd missed a hospital catch by about 60 seconds.

Pitocin was pumped into her IV and an IM methergine was injected. There was no bleeding. Her placenta was born within a couple of moments, but still no bleeding. I was so relieved and firmly believe that having the IV in place with the meds kept her safe. There was no tear this time and mom was thrilled!

Despite the stupid IV placement, mom began nursing her 4th daughter and we talked and shared thoughts and after about 90 minutes, it was time for me to go. The rest of the family had already gone.

The next day, I talked to mom who told me the IV was still in. She'd hemorrhaged 4 hours after the birth!

I felt weak as I imagined that happening if she'd delivered at home. Even if we had had the IV in... even if we had kept her from bleeding initially... if she bled 4 hours postpartum, she would have been alone and had to be transported - alone. Our decision to transfer was the right one.

Mom, 2 weeks later, is doing well. There are sad moments of not having her so-hoped-for homebirth and we'll keep talking about it and working through it.

4 beautiful girls.

An alive mom whose bleeding was controlled with meds.

How blessed to live in these times.

25 Hour Precipitous Delivery - Part 2

2004-11-13T17:33:00.000-08:00

Labor started and stopped several times throughout the night and day. Walking, thinking, sitting... sometimes they would come... and others, they would go. There didn't seem to be much rhyme or reason to their flow, and it was frustrating at times, sleepy at others.

I was asked to do a vaginal exam a couple of times (by the mom) and could see that she was dilating even without contractions. Starting at 2 cm, she then was 5 cm several hours later.

After about 15 hours, mom tried some blue and black cohosh, but the two doses caused dips in the baby's heart rate... from the 150's down to the 110's... so we abandoned any more of that. I didn't want to move to castor oil either, because if the baby was having moments of difficulty with B&B, then what would she do with something more aggressive?

The two midwives working with me were great. During the night, they spooned on the couch because it was freezing in the house. I slept in the car for awhile, then in one of the children's beds, setting my phone alarm for every hour to listen... and then not listening at all from 3-6 am when we sent everyone to bed and we all slept for 3 hours straight.

Once up, that was when we tried more walking and the B&B, and at one point, I was really, really tired and needed to sleep and one midwife, too, said she would, so I asked the third, the only one there not being paid, to hang out with mom. She had this great idea to get her out to walk. (We'd all suggested it for HOURS for her to go out and walk... seeing expanse, not walking in circles around the back yard, really walking and not strolling... but she wanted nothing to do with that.) I chuckled as I readied for a nap, knowing mom wouldn't be going out (modesty, needing to pee lots, and headstrong desires), but was amazed when I turned the corner and she was putting make-up and clothes on to head out!

I went for my nap and awoke feeling a distinct shift in energy. Finding everyone, mom was on the birth ball in her pjs after her walk(s) and having an inward energy.

This client lives at her in-law's home, so we spent most of the labor in her bedroom. Very modest, she sat on the ball in there, laid in the bed, sat on the chair occasionally. She also is a doula and knows the ins and outs of getting labors going/continuing. She knew her history of hemorrhage. She knew she could/should be out walking more. She told us as much.

She knew the energy of those around her could totally affect her labor.

Yet, she sat in the room, laid on the bed, and had invited her mother, an OB nurse, to the birth anyway. Her mom, from pregnancy, was disturbed about the homebirth. She hadn't been told about it last time because the client knew what she would say. After the transport experience, mom was so angry she would attempt a homebirth again. 4 midwives showed up at the 36 week home visit and answered all the mom's questions.

Yes, we understood the risks.

Yes, we were going to put a hep lock in (saline lock, actually) and have a 250 ml bag of LR with a pit and a meth in the bag for her.

No, we didn't want a homebirth if it wasn't going to be safe.

Yes, we all have practice with hemorrhages. (2 LMs, 1 CNM, and me)

Yet, once in labor, mom was a pill. She could not stop making comments about how dangerous her daughter was being. I could tell she was really trying to not be so mean (it could have been worse?). Sometimes. Just like docs play the "if she were MY daughter..." card, this mom also played that card: When their daughters (meaning us midwives) are the ones in this position, they can make their own choices.

Never underestimate the power of pitocin.

You have three other kids to live for, why are you putting yourself at such a risk?

How long will you give her (with her membranes ruptured)? (My answer: until she delivers)

During pow wows together, one midwife wanted to find the psychological reasons for her labor dystocia. I didn't care. I also knew the mom better and knew her level of compliance and desire to actively participate in her pregnancy, labor, and birth. It just wasn't her thing to DO something. Later, when the walking midwife's husband brought their baby to nurse (she'd run out of the house without the pump), the client told me how much she hated the walking. The midwife exhorting her to walk faster and she walked so much she sweat. At one point, she begged to go to the bathroom, and when she opened the bathroom door afterwards, the midwife was there again, ready to walk and walk. The client, momentarily compliant (read: open to the power of suggestion), headed out again. When she got back to pee the second time, she said she felt yucky so wanted to shower. The walking midwife thought that was a great idea! She could stimulate contrations in the shower... nipple stimulation and more. My client took a 3 minute shower and reappeared with her pajamas on. The walking midwife was so disappointed they weren't heading out again.

I didn't have the energy to deal with the "why's" of the clients desires. Why did she invite her mom in the first place? Why did she allow her mom to say these things outloud? Why didn't she tell her mom to shut up? Why did she tell us "no" that we didn't need to say anything to her mom about a positive attitude? I didn't care at that point. Those things could be explored later because they weren't going to make a whit of difference with this mom (or this type of mom).

Instead, I wanted to explore what was going on physically. Mom didn't want me to strip her again. She asked for a vag exam, but pushed me out after finding dilation quick and fast. She was continuing to dilate with no contractions.

And we didn't have the Hep lock in.

When we arrived, I had everything laid out and one midwife tried to get the IV going, but couldn't get a vein. After she tried twice, the other midwife tried and didn't get it either. Now, this mom was a champion sport in allowing herself to be poked so many times. The second midwife tried 3 times and couldn't get it. The OB nurse grandmother looked and wouldn't attempt a vein anywhere. We abandoned the IV plans. Red flag for me.

It was about 18 hours after her water broke when I started hints about going to the hospital. Her mother was dropping bombs whereas I was trickling droplets about it. By 20 hours, after another pow wow with the midwives, I really thought it was best if we go since she continued dilating... was a 5-6 at that point.

One midwife was missing and she had asked us to only call in an absolute emergency (she was in the northeast looking at fall leaves with her husband; her first vacation in years). The client said she wanted to know her opinion, so I called and left a message since she didn't answer. I went back in and said we might just have to make a decision without her.

The three midwives and I sat on the client's bed and talked with her, her husband, and her doula about the options ahead. If we had the IV in, it would be safer with how silent her labor was going. I was very concerned that if she kept dilating, that eventually, she would have a baby, yet also have a uterus that was in complete atony and she could bleed as we did bimanual compression, give IM meds while waiting the 3-5 min for them to kick in and allow EMS to arrive as she, once again, had a harrowing, naked experience in an ambulance and in the hospital. I felt controlled was a much better option. It just took her time to ponder the options herself.

What were those options?

* Stay at home and wait to go into transition (going into labor wasn't going to happen)

* Go to the hospital without a fever, without meconium, without contractions and have pitocin (we felt that, surely, she would have a whiff of pit and cough the baby out) and leave asap afterwards.

* Send us home and call us when labor kicked in (that wasn't remotely going to happen, but was certainly an option)

She loved her doctor, who, apparently, backs up another midwife in the community (whom I have never met), but he was away in Africa and she didn't want anyone else. I asked her to call his office and ask when he got back and they told her he'd been back for 10 days! They said he was on-call at the hospital (the term is Doc in the Box), so the client called L&D and found her beloved doctor.

I met this doc last time after her transport and he was very kind and loving. He never gave her a hard time about the home birth and, in fact, didn't even give her grief about wanting another homebirth this time! Something other docs, even supportive ones, would have had cows over.

The doc suggested she come on in, sniff the cork (of pitocin) and have her baby. We concurred.

While mom was making her decision, her mother came into the room and stood there. The client told her mom she was hearing about her options and the mom said, "you know your options already" and the client said, "without you. I want to decide without you" yet mom stood in the doorway as we sat in uncomfortable silence waiting for her to leave. She ended up stomping off and the husband closed the door gently behind her.

She had made her decision and once it was voiced, began gathering her things for the hospital -stopped at one point and cried. I pulled her into my arms and cried with her as we shared the disappointment for what she wanted so badly and what we had worked so hard to accomplish. I didn't make any comments about safety or this is for the best or we tried everything. I merely held her and cried with her as she mourned her last opportunity for a homebirth that was beautiful and gentle. (She would have no more children... it was already a surgically done deal.)

She finished getting ready and we packed my midwifery equipment up and got it into the car. (God, I love my organized birth kit! It set up and broke down in mere minutes!)

25 Hour Precipitous Delivery - Part 1

2004-11-13T17:24:00.000-08:00

Yay! She had the baby. I'd been up since 5am and Athena was really pounding my head (but not quite as bad as when I almost called 911), so I left childbirth class early so I could go home and go to bed. On the way home, I called Sarah and I was hungry, so we were going to stop at Wendy's for a quick bite (she was on-duty).

She'd waited for me at the end of the ramp, but I headed to the next exit as she got onto the highway in front of me to do the same. She was further ahead and I couldn't see her, but I expected to at the light at the end of the ramp. When I didn't, I asked where she was and she told me as a red Izuzu came flying past me and the ran a way red light and continued speeding towards Sarah. I kinda gasped and screamed as I told her about the guy and said he was coming up behind her on her right.

And she got him.

laugh laugh

I went to Wendy's and sat in the car waiting for her while reading.

My client (J) called saying she'd either ruptured her membranes or was wetting her pants. I was on my way and called the other 2 midwives to alert them. My original back-up was still seeing fall leaves in the northeast.

Getting to her house, I gave her some nitrazine and she showed me it was, indeed, a deep blue color; membranes broken!

I called the other midwives who were hurrying over (remember, her last labor was half an hour... seconds after her membranes ruptured... and she'd hemorrhaged so badly she needed to be transported. I missed that birth, but made it for the hemorrhage and got her antecubetal [inside the elbow] vein to start the IV before the transport. Her Hgb 4 hours postpartum was an 8... transfusion material right there, but Hgb's go down over the first 48 hours before showing the true hemorrhage experience; she wasn't ever tested after the 8) and I began setting up.

Setting up for myself was relaxed and comfortable. I have been exhorted to set-up by other midwives when working with them, but for myself, it was gentle and easy. I'd already arranged my bags appropriately (although, rearranged them some after the experience of using my new organizational skills), so it wasn't so difficult getting things out and in their proper places.

We knew we were going to do an IV, so I pulled the equipment and supplies out for that and set them on the chair. The oxygen was on and readied, the birth equipment in my new carry-all was ready on top of the oxygen tank, the blankets and towels and washcloths with one hat were sandwiched between the heating pads on my NEW resuscitation board a client made for me last week (I love love love it, but the way... he made it with a handle cut into it and it is sturdy and holds all the equipment perfectly for the baby! I told him to come up with a price because other midwives are going to want one, too... it fits perfectly in a standard pillowcase. I have wanted one for years!), got the stuff out of her bins... Chux, peroxide, etc. and had things where they needed to be and removed things from the small room when they weren't going to be needed for awhile. I was pleased.

Sarah called in the meantime and asked where I was and when I told her that J was going to have her baby, she asked if she could bring me food. I told her sure! and then later realized she was in uniform and how humorous this could be.

We talked about crampiness and bloody show (there was none), that I didn't need to do an exam until she asked, but that I wanted to minimize them and she agreed. I'd taken vitals before even setting up and began charting the labor notes and forms that come with birthing (dates and times of significant events in labor); all was great.

Sarah arrived all bulky in her cop uniform bringing Wendy's. She sat at the kitchen counter waiting for the rest of the folks to arrive as I continued going back and forth setting up. Her mom came in breathless... is the baby here?!? why is the Sheriff here?! And we giggled, introducing Sarah as she sat eating her Wendy's. Friend after family member, the same scenario ocurred as J laughed about their nervousness when she was still walking around.

The first other midwife arrived, not nervous, knowing it was going to be Sarah and she laughed seeing her in her uniform as opposed to nice clothes at the office. She is SO imposing in that uniform!

The other midwife arrived and we began our sitting and talking that would continue through the night and into the next day.

VBAC Birth Story - 9/28/04

2004-09-29T05:31:00.000-07:00

I rolled over in bed this morning (about half an hour ago; it's 4:25am right now) and felt my muscles tight. For a moment, I couldn't think of why. Oh, yeah! I helped a woman have a VBAC Tuesday morning!!!

What an AMAZING birth that was, too.

A woman with a baby almost 11 pounds last time... she'd gone 43 weeks and was induced with cytotec... pushed for several hours, and then had a cesarean, wanted a VBAC very badly this time. Not many of the docs would give her a chance; she found one.

When I met her, she was about 34 weeks pregnant (maybe a tad earlier)... she'd been sent to me from another doula who isn't taking clients anymore... and she came to one part of the childbirth class I teach with Konuwena at the office. She was delighted, but knew her husband would have hated it (too hippie for him). After the class, she and I talked a lot about her last birth, this pregnancy, and her wishes for this birth. In discussions, we talked diet. While she wasn't GDM last time, she ate tons of ice cream and dairy last time... and beef. I encouraged her to re-think that this time... to stop those high calorie, high hormone foods... and work at growing a smaller baby since it, most likely, WAS a baby that wouldn't fit through her pelvis (she hadn't been in bed at all during the previous labor).

I went and met her family and her husband and I got along nicely and I loved their son... what a cutie! We decided we were a good fit... what my role would be... how we would play this out, etc. It was a pretty typical sort of "birth plan," but I was mostly wanting to know how far she would go with a VBAC desire and how she would cope with another cesarean. She and her husband were a great pair of folks who were open to anything that would happen... not intensely married to the VBAC and wouldn't be depressed, just mildly disappointed, if another cesarean became necessary. These types of people are the easiest to work with sometimes since small nuances of change don't topple the entire pyramid of hopes and dreams. I find that those who are brick walls of hopes and dreams (the absolute To Think Is To Create people) create much more sadness and disappointment in their experiences than those who are able to "go with the flow" of labor which is, as many know, a fluid rather than a solid.

My cell phone had died, but Sarah and I went and got a new one Monday night... a new bright red one to go with my bright red DayTimer to go with my red Explorer... but most people didn't know I had a phone again, so I woke up at 7am and found an email from this client that she had been up since 5am or so with some contractions; please call when I got the note. I called and she was talking through contractions and said I didn't need to come over yet, so I did more email (the computer was still down at work, so I had PLENTY to catch up on) and got a call again at 8:30am from her husband. I always know when the man calls, it is time to head out. He said her water had just broken (it was clear). Asking what the doc had suggested (knowing), he said he couldn't remember, so I said he should call and ask and I quickly got ready and was walking out the door when he called back and said, "Meet ya at the hospital!"

I got to the hospital about 40 minutes later (traffic!) and walked in to find her 10cm! She was 9cm in triage, but progressed fast... feeling some small urges to push, but not pushing terribly hard as she waited for the doc.

Once he came in, he suggested she kneel (she has knee issues, so squatting wasn't good for her) and I parked myself at the end of the bed as she kneeled onto my body... I held her up as she leaned and pushed with each contraction... just when she needed to. They were short, but she pushed (not as effective as I would have liked, but I encouraged her pushing when she did) and she was so tired already. I smiled and reminded her how women feel this right before their babies come... that she was right on schedule. We did a few of these kinds of contractions and her husband, who is very tall, moved into my spot and I asked for the squat bar.

The squat bar was brought in and she used that instead of her husband or I, but I squatted in front of her, on the floor, looking up at her as she pushed; we pushed together. It was great. SHE was great! We played with pillows so she could rest inbetween contractions... her leaning down on her elbows sometimes on the bed, other times, her head on a pillow on the bar... each time kneeling/pushing/opening with contractions that were petering out... spacing out and shortening as time passed.

The baby, also, was having some decels after her contractions... not the most fabulous to hear. We had her breathe deeply with each resolution of contractions and the baby liked that lots.

Once, she said she couldn't do much more... that she wanted to have surgery. I asked her if she wanted me to remind her of what she told me she felt after the last birth... the pain, the sadness, the frustration... and she said she did, so I did. Another time, she said, "I can't do much more" and I said she didn't have to, that she was almost done. Then, at one point, she looked me in the eye and said, "I can't do anymore." I asked her what I could do to support her... did she want me to keep encouraging her, because I could... or did she want me to support her choice for a cesarean. She said, "I want a cesarean."

I told the nurse who said she had to get papers, but put the IV tubing onto the Hep Lock she had on her arm before leaving the room. Mom wanted to lie down, the nurse was inputting stuff into the computer, and said, "sure!" so I helped her lay down on her left side. Immediately, the baby's heart rate began lowering... I flipped her to her right side and the heart rate climbed slowly, but stayed steady. Her contractions had nearly stopped and she laid there as I talked and explained about people coming in, having the spinal, the Bicitra (the stuff you drink before surgery that neutrilizes stomach acids), etc. and the nurse went to find the doctor.

The baby's heart rate continued doing funky things and mom said she had been hearing it and that scared her, prompting her to want the cesarean sooner than later. I told her that she was making the perfect decision for her and her baby and I smoothed her hair as we waited.

The doc came in and said he wanted to check one more time and gloved and did an exam and asked her to push. She said she couldn't and he said, "PUSH!" and she did... and that baby came DOWN onto the perineum! WheeeeeeHA! we were NOT heading to the OR!

The doc gloved again (wrong size gloves) and asked her to wait as we watched the head beyond a crown. I encouraged mom to touch and she was awed by what she felt. I asked the doc if I should go get a nurse for him and he said, "uh, sure" so I stepped beyond the curtain and told the nurse... baby's coming!

Back in, the doc got the right sized gloves on and the baby was being born... up to the arms coming out, the doc asked her (told her) to reach down and take her baby and she reached down and grabbed her baby and pulled him out of her body. It was magnificent!!!

She exulted: I DID IT!!!!!!!!

And we all were SO thrilled! She started crying, her mother (who'd never seen a baby as this mom was adopted) was crying in the chair across the room (she came in for the birth only), and her husband was so happy! It was the coolest thing! I wish I'd had a camera to take a picture of her scar with that baby coming out of her; it was PERFECT!

I was so proud of the doctor for continuing to believe in her. I was SO proud of the mom for that magnificent push she gave the doctor! I'd suggested a number of times that perhaps someone's fingers inside might help her focus where to push (it can also help the urge in a time of contractions leveling out), but she didn't want that, so I didn't do it; it turned out that was what she needed!

This baby was nearly 2 pounds lighter than her last one. The baby was born at 39 weeks and was bribed to come out with "you can have ice cream when you come out." I laughed!

How wonderful... what a great outcome.We are all sore. We are all jubilant!

Afterthoughts:

The baby had some facial bruising indicative of a posterior rotating baby. Near the end, she complained of hip pain, which would be the baby rotating through. I believe that when she was on hands and knees, the baby wasn't as able to rotate, but when she laid on her side and then flipped to the other side, that baby floated around, too. I firmly believe if she had stayed just upright, unless she could truly squat, the baby might have stayed in a rotating (acynclitic) position.

At one point, the nurse asked if I was an L&D nurse because when the heart rate wasn't able to be heard, I would hold the monitor on her belly so we could hear. And various other reasons, I am sure (seeing that an internal monitor would be far easier on the mom to listen to the baby and suggesting it as an option... by asking if that was something she didn't want first and she said she didn't care, so we talked about it for a few moments and she said, "do it so you all don't have to keep pushing on my stomach," so an internal was put in on the baby)... knowing where the chux were, the washcloths, etc. I didn't get squeamish about watching for the head or changing chux. I told her that, no, I was a midwife, but that I had tons of experience in the hospital. She said I was a great doula... much better than most she ever saw. I thanked her kindly.

Later, we talked a little about doulas and how they get more married to birth plans than some couples do and she said she sees it all the time. I told her that I was there for the mama... to help her feel happy about every choice that she makes, even if it deviates from that Perfect Birth birth plan she'd created in her mind. The nurse thanked me for my realistic attitude and I told her it came from 22 years of watching birth and life in all settings and my belief in birth.

As I walked out when I was leaving, she took my hand and said I really was the best doula she had ever seen here in San Diego... thanked me lots for being there, that I had made her job easier by far... and that I was just great with the couple. The couple had already hugged me warmly (as did the new grandma) and told me I was GREAT!

I was high as I got in the car to head to work. A great birth. What a "job" I have, eh?

Sukkah Birth (last night)

2004-09-20T16:09:00.000-07:00

I was asked at the last minute to assist Gerri... love working with her, she and I being nice and hands off. She is the midwife that was at Donna's birth, too.

The woman's water broke at 9pm on the 18th, but no labor for about 12 hours. When Gerri went to check on her, she was still in very early labor, so she and her daughter (a new doula) came to the Reclaiming Birth Conference meeting we were having at Ama Mama on Sunday. Donna was coming to the meeting to help with Registration, so it was vital to have the meeting.

I'd been awakened by Gerri's daughter at 6am telling me to come now, but then, stepping into the car, Gerri said she was still really early.

The Con meeting was at noon.We had our long meeting (I talked to a couple of the women until 5pm!) and then napped until I was awakened at 6:15pm by my pager telling me to come up the mountain since it was still kind of light.

I woke up, gathered all my stuff together (I have been organizing my birth kit for a couple of days), and headed out. I wasn't going to make it before dark.

As I headed east and then north and then up this mountain, I saw what Gerri had warned me about; the cliffs that fell quickly if I took my eyes off the road for a second! I followed the directions very slowly, brights on, paper in hand and found my way to the steep hill upward that would then level off at their home that was in the midst of being constructed upon. If I gunned it too much, I would head either off the cliff on the left side of the driveway or into the embankment they were building to protect against mudslides in the rainy (*cough*) season. I didn't do either, so I must have found the correct gas pedal pressure.

Mom was in the hot tub (Aqua Doula, actually) and I quietly asked Gerri what she needed me to do; she said nothing, so I acclimated myself to Gerri's oxygen tanks (location), the med kit (by the O2 tanks), and other supplies. Gerri's daughter was her fetcher, so I grabbed my organizing Bible and sat in the livingroom reading. It was freezing outside! (60 degrees according to my car thermometer.)

I could hear mom's beautiful labor song... moaning, sometimes squeeking, and her 4 year old son (who is still nursing) talking to his mom and dad, being tended to by a beautiful teenager who had seen other births (her mama had had a baby with the midwife here in town who'd spent time in prison).

This mom loved the hot water. Periodically, I would open the door for the doula/friend as she carried giant spaghetti pots of boiling water to the tub and gently immersed the hot water into the tub with a coffee cup.

I love being in other people's homes. It is so cool to see how people live. I would say these were homesteaders, except for glaring paradoxes: only wooden toys in the house, but a state-of-the-art computer system; hundreds of books, many on simplifying, but a large flat screen tv in the living room; dozens of aromatherapy bottles, but an indoor toilet; only organic food in the house, but 2 cars of theirs in the driveway. So interesting!

Gerri asked me once to come and listen to heart tones as she charted, so I leaned into the tub to listen (after asking permission) and the baby sounded wonderful! Dad had gotten in the water with mom by now, too.

I was reading again and could hear her beginning grunts through her song and Gerri's daughter came in and told me she was starting to push. I smiled and said I was listening and thank you for letting me know, that I was right there when her mama needed me.

The contractions spaced out as second stage contractions are wont to do and as soon as she started pushing from the beginning of a contraction, I wandered outside into the cold night. It had started sprinkling.

The hot tub was tucked inside a corn stalk teepee sort of creation... like a sukkah Jews make during Sukkot (http://www.torah.org/learning/yomtov/sukkos/succospictures.html), but with much less substance. The sky was easily seen through the top and the rain sprinkled down on our heads gently. Stars peeked out when the clouds passed by. I don't remember the moon at all, but know it isn't full (despite it bringing 3 babies in our practice within 12 hours of each other!).

Mom could feel the baby moving down and she was on her hands and knees... a very small woman... she knelt her knees on her husband's thighs and she clung herself around his neck... nuzzling him as his face was pure bliss at his wife's sheer determination and focus at birthing their baby. The 4 year old was asked to come into the water by mom and he jumped in, sweat shirt and all. I watched quietly, finding myself pulling back against the teepee to offer them privacy and room; Gerri did the same.

We could see the head coming with the tiny flashlight, otherwise, it was dark except for the light from the living room window that was shaded. I took off my sweater and Gerri asked if I wanted to bring the O2 over (it was behind the teepee, behind me) and I said I could grab it fast, but I didn't think I would need it. (I didn't say it in that many words and it was said almost silently.)

Gerri asked mom to feel her baby and she kept shaking her head "no" into her man's shoulders; I could see her biting him. I touched dad's hand gently and reminded him that he could touch his child's head if he wanted and his face lit up even more as his left hand found his baby's head and he told his wife how wonderful it was that the baby was so close!

There was no talking between contractions and the closer the birth was, even the young child was more quiet. We couldn't hear cars, birds, bugs, or anything else but the birthsong. And it was perfect.

Mom's voice arched and we watched the head slide out easily... a baby with its eyes closed, facing up (mom was still on hands and knees) and the sibling came close and was hesitant to touch even as we whispered that it was okay to touch softly (so's not to stimulate the baby).

Instead, we watched with amazement and joy and waited for another contraction. As it began to build, mom reminded her son that he was going to catch the baby and, instantly and in slow motion, two arms popped out at the same time! All that was outside of her body was a head, shoulders, and two arms... reaching... and the baby's brother reached over and took the baby's arms in his hands and we encouraged mom to lean back so the baby could leave her body and she would be able to hold her baby... and simultaneously, she leaned, the son helped the new baby out (Gerri was close, but not touching) and right onto his mama's tummy and they all laid in dad's lap/chest/heart. I couldn't stop smiling!

I watched to make sure the baby was doing well. Her eyes were open, but she didn't make any noises for about a minute or so, but she was pink, her eyes open, and her cord, we could see (we didn't touch) was pulsing hard. Once she began breathing, she made one or two little wahhh's and then she just sat there and looked around. We didn't know she was a she for a few minutes, but everyone looked and verified that the new baby was, indeed, a girl.

The new baby closed her eyes after a couple of minutes and mom was worried, so I asked if I could feel her heart rate and mom said, "anything you need to do, just do it!" but it was important for me to ask anyway. (She doesn't know; we do.) I felt her chest (no gloves) and her heart was at least 140-150 and I put mom's and dad's fingers on her chest so they could feel and they were reassured... much better than if I told them blah blah blah... it is always better to feel than hear, don't you think?

We dried the baby's head off and put her warm hat on. No towels or blankets since they wick wet to the baby and make them even colder... better to keep them submerged. I took that coffee cup from earlier and gently poured water over the baby as mom, dad, and older sibling talked and spent time together.

About 15 minutes after the birth, mom wanted to move to the couch because she was getting cold. In the strategy (discussion) of moving a mom with a placenta inside that has its cord still attached to the baby that mom is holding and out of an Aqua Doula (that is pretty darn tall, especially since she was short), we choreographed it well and there was zero bleeding so no need for the Chux Holder between her legs either. There was one person on each side, one behind, me in front (hands near the baby) and we 10-legged walked into the house, putting our feet into the water bucket before entering to get the sand off.

Mom sat on the couch and began nursing. In time, she spoke of contractions and her back hurting (tailbone), but Gerri thought it might be from the birth (rotation). I have heard many women describe that sensation when the placenta is sitting in the vaginal vault, but not yet out. About 40 min after the birth, Gerri suggested we move her and I suggested a supported squat. Great idea, Gerri said, and we did just that... and the placenta plopped right out. The backache stopped immediately. smile

There was less than 200cc blood from this woman. Her uterus was tight and hard and 2 fingerbreadths below her umbilicus already! I wasn't needed anymore.

The baby was nursing great, had already had her first poops, and the family was enamored with their daughter... 7 pounds even, Gerri tells me today.

This beautiful baby was born 24 hours and 1 minute after mom's water broke.

Her middle name is Summer... and, what a beautiful birth to attend on these waning days of summer.

I am honored and blessed.

Assisting the Midwife

2004-08-31T16:06:00.000-07:00

I was invited to assist at the last minute because the other assistant was dis-invited. I'd expected to attend this client's last birth, but didn't go for whatever reason, and was surprised to be invited this time, but glad.

Mom wanted the baby on her husband's birthday... so badly that she had acupuncture, was stripped more than once, and prayed hard to deliver on his birthday. On that day, she was in early labor... 3-4 cm dilated and contracting regularly. Once midnight passed, however, contractions stopped and she breathed a huge sigh of relief that the pressure was off.

5 days later, she began labor in earnest.

Third baby, last labor was 4 hours long. I was called to come at about 11pm and flew the 30 miles in 20 minutes (I swear I didn't go over 90 mph!). Once there, mom was chatting, moaning with contractions (that were very short!), and wandering around the neighborhood. I slept on the couch as best as I could.

Hours later, mom wanted her water broken. She said that last time they broke her water and the baby came. She wanted the same trick this time. The midwife came and asked me what I thought. (I was downstairs. The client was very specific in asking me to allow her midwife to speak and Be the midwife; I honored that implicitely.) I asked the midwife if she might delay the ROM in the hopes that the baby would come first, so she bought the bag another 90 minutes or so before the mom demanded the membranes be ruptured.

Interesting aside: Does doing what the mom wants include interventions I don't feel are necessary?

The midwife broke the water... nice and clear, but the baby's heart rate went down fast and we moved her to her side and it recovered. She got up and went into the pool... very discouraged that this birth was so much longer than her last one... even longer than the first.

There are tales of third babies and boys doing what they want to do... patterns be damned. This was a third baby AND a boy (she knew already), so we just shrugged and told her she was doing great and encouraged her to hang in there.

Earlier, she told us that she had been so very tired with the girls' births... this one, she was awake! During the time after the ROM, she told us, over and over how tired she was. I reminded her how she said that about her last births and now she was there... at that place of close-to-delivery; it seemed to help.

Her hips were hurting. With nearly every contraction, she moaned about her hips and how if that single pain would just go away, it would all be fine. After the birth, I told her that every woman had that one thing that, if it went away, the birth would have been just fine. For some, it is hips; others, their back... still others, their belly... others, the nausea and vomiting. Every woman seems to have at least one major complaint about their labor that, if it would just go away, the labor would be tolerable. I smiled knowing my own complaints.

I spoke as little as possible, but whispered a lot to the midwife because she kept doing vaginal exams. The mom had a cervical lip and the midwife tried to push it out of the way. I cringed. Once the mom had her membranes ruptured and moved off the bed, she got into the pool on hands and knees and wanted to PUSH. The midwife wanted to check "just in case" and I whispered to her that she didn't need to... if the mom wanted to, let her... if it hurt, she would stop. She didn't quite take her hand out of her vagina, but she pulled out some and when the mom had a contraction, she pushed fiercely! The midwife asked her (hesitantly) if it hurt and she howled NO! and then the head was on the perineum.

Once the head was born, the mom was resting, but the midwife got nervous and began pulling on the head, well, it is traction (lifting and lowering the head... most people describe it as pulling, but there is more to the motion than that) anyway... I told her it was fine... she could wait for a contraction, but she wouldn't. She instructed the mom to PUSH as if there was a problem (there wasn't). The baby was meowing... his lips were pursing and opening... so lovely! She had just begun a contraction as she was pushing to the midwife's exhortations and out came his body to his waist. The midwife asked mom to lean back and pushed the baby through her legs and mom grabbed the baby the rest of the way out of her own body. Beautiful!

I waited a few moments (but know that this midwife was trained to listen fast for heart rate and respirations) and then gently listened as he took his first great breath. He was quiet... and perfect.

Immediately, the mom asks if she is peeing or something and we look down and the pool is filling with blood... like ink gooshing into clear water... the midwife wanted her out of the water. We lifted her and got her onto the makeshift space on the floor lying against the most gigantic bean bag chair I have ever seen and blood continued to flow. The placenta was right there, so the midwife delivered it (Duncan) and my hand went right onto her boggy uterus.

With every massage, blood squirted out... over and over, trying to get the uterus to do its job. We gave her oxygen first because she felt funky and was getting glassy-eyed... then a homeopathic I can't remember right this second... and then, finally, a shot of pitocin that we had drawn up because she'd needed 2 last time. The pit quelled the bleeding after a few moments. I gently touched her fundus to make sure things were cool and only once did I have to rub up another contraction for her because then this cute boy latched on and didn't let go!

We cleaned up and the midwife thanked me lots for sharing my patience and belief that we don't have to make sure the cervix is out of the way to birth the baby. It was funny. I felt SO relaxed... even during the bleeding... even when he hadn't taken a breath... that I figured out that it was the midwives around me in many instances that had made me nervous and act in ways I didn't believe I should... not necessarily my own fear. I loved that realization!

This was a quiet, gentle, loving birth. There were ways I wouldn't have acted, but really, it wasn't my client and the client chose the other midwife. I was there to serve the mother AND the midwife.

I feel good that I did both.

Humility?

2004-08-20T13:53:00.000-07:00

Why isn't it important for some to learn humility in pregnancy?

I heard a midwife once say, as she recovered from her 50+ hour labor and cesarean, "I never had any idea. I thought I knew birth. I had no idea what giving birth was about until this experience." This was a woman who had been a nanny, a doula, and a midwife for years.

Why was it that, during her pregnancy, when her midwives (not me) tried to speak to her about her I Will Never Go To The Hospital Unless I Am Dying or The Baby Is Dying attitude, didn't she listen... couldn't she listen? Isn't it painfully obvious that the more we resist something, the harder God/the Universe is going to shove it into our faces? Isn't surrender our lesson on so many levels? So much of the time?

By her own admission, she said she didn't even go to the Cesarean Place in her preparation; that just wasn't going to happen to her. She said until the second day of labor, she just couldn't even think about the hospital except for it being I AM NOT GOING THERE.

Then, as transport became obvious, cesarean thoughts were still non-existent.

Midwives are not immune to delusional thoughts of perfection any more than a first time mom who has never seen birth... and what birth can do as it unfolds... even without your help (especially without your help!).

She didn't even consider a cesarean for many hours with her cervix unchanged. Peace decended once the decision was made; she was going to meet her baby. Finally.

Nursing was a struggle and included formula to quell the screaming cries of the baby (I offered breast milk from donors), many pain meds, a uterine infection, incredible incisional pain, and the enormous mourning of the Birth Dream she had had her entire life. All things that were a Never Me belief in her world.

Never, ever say Never.

She tells the story that she is nothing like the midwife she was before her birth story. While she still feels that women can be fantastic midwives who haven't had children (as I do), she now knows, on a totally different level, the amount mothers are willing to sacrifice for our children... sometimes just to be born.

We have spoken about understanding why women would choose an epidural, why women would choose hospital births, how some women truly are in excruciating pain even if they have Hypnobirthed, Meditated, Yoga'd, Prayed throughout their pregnancies and lives... readying emotionally, physically, spiritually, intellectually... for the birth before them. UCers are wont to say that it is a mental thing, that pain crap. I sit quietly and shake my head and pray that they never experience what I have seen some of the most Holy Women on the earth experience as far as pain in birth goes.

If'n yer baby wants you to scream in pain, yer gonna do it... no matter how evolved you think you are.

However, my friend... my midwife-friend... she says her midwifery will never be the same. And neither is mine.

(Not) Love at First Sight

2004-08-17T18:35:00.000-07:00

All these women over the years who hide their shame... I hear it over and over during subsequent pregnancies...

whispering

I didn't love my baby at first. I hear you, that is pretty common. No, you don't understand. I didn't even like him at all! It took days (weeks/months) to actually believe he was the same thing that had been inside me.

Was it:

the epidural?
the morphine?
the hospital?
the cesarean?
the doctor?
the forceps?
the vacuum?
the fight with my spouse?
the crappy babyhood I had?
the general anesthesia?
the exhaustion?
the surreal-ness of it all?
the real-ness of it all?
the fact that I wasn't ready to be a mom?
that I was a teen mom?
that I was an older mom?
that I was a single mom?

and the list is endless.

I think that those of us who see with our eyes tend to react differently than the blind women I have seen. Blind women (and I have only been with a couple in all these years, but I have talked to other midwives and doulas about this) tend to smell and feel... it is just different for those of us who use our eyes... our culture is just so... visual!

But, what of those of us who have reactions that have nothing to do with looks? The indifference after a long labor and/or complicated birth? What would happen in the wild? I believe the midwife would be the one to assist that new mama... holding the new baby to mom's breast... kicking in some hormones that help with the "bonding" stuff. I don't believe many babies in the wild born to exhausted moms were just left to fend for themselves as mom recovered.

Why does this happen? I wholeheartedly believe we are biochemical beings as much as Spiritual Beings. Low glucoses, long labors, quick labors, being denied food and drink for many hours, medications, stress, immobility, fear... all those and more all combine for a terrific combination that can really do a number on the biochemistry of a person's body! Add to that being cut open, having your child taken out, your guts rearranged, sewn up, more meds pumped in... all of those are major reasons why someone might not Be There for their child the way they had dreamt it would be.

Unfolding.

Unfolding is a lesson I have shared several times this week.

I know many people who watch movies and within 5 minutes have the entire ending in their expectation. I hate watching movies with these people IF they speak about it outloud. Sarah is forever second-guessing what people might do (could be a good cop trait, however)... trying to figure out why Aimee does this or the other thing... how come Tristan doesn't do such and such.

I am not like that. I learned a LONG time ago to allow things to unfold. I learned to not anticipate in movies... that way I was rarely disappointed. I never anticipate gifts, letters, cards, or thank-you's; therefore, they are always a delightful surprise!

In birth, as a midwife, if I have expectations of how someone will do/react to something, I am not only setting myself up for disappointment, but also setting HER up for failure. It doesn't mean I don't anticipate issues... shoulder dystocia, hemorrhage, etc. It doesn't mean I am not ready to resuscitate at a second's notice. It just means that I allow women to unfold in their births.

The biggest issue I have with childbirth classes is the Visualizing the Perfect Birth exercise... IF it is done without discussions of how even the most unpredictable birth can be considered Perfect (even with death). It is all fabulous to meditate and create, over and over, your birth. I absolutely believe in playing out how things will go. Shoot, I did that when I had the lumbar puncture and it did go as I rehearsed it! But, contingencies must be addressed or the class is failing the "student." Miserably.

No one (most no one) talks about the feelings that can appear (or NOT appear!) after birth. Who wants to hear that women hate their children or are indifferent or want them to go be adopted? Pregnant women who haven't experienced such intensity would/could judge harshly and the I Would NEVER Do That fall out of their mouths as if they were defending their very right to be a parent. I would say that at least a quarter of the women I have spoken with in these 20+ years have had this experience of Disbelief in Emotional Reactions after their birth. The entire gamut represented.

Gerber ads, formula ads, marketing, advertising, La Leche League pamphlets, magazines, etc. all push, Push, PUSH women to believe they will fall instantly in love with their newborn. Soft focus lenses and spaced out close-eyed stares from mother to infant... it all looks so good you could lap it up with a spoon.

A birth story unto itself, but one of the women I was second assist for labored for 20+ hours at home, pushed for 3 hours at home, another 2 at the hospital, a vacuum attempt (x3), the failed placement (x3) of an epidural THEN a spinal try, and then the baby freaking, the mom being put under general anesthesia and her baby born by cesarean. She didn't see her baby for over 2 hours, but dad held him and we all loved him lots.

The baby is almost 2 now and mom is still so freaked out at how she fucked up this kid's first hours of life on the earth. She has rebirthed with the child, has had cranio-sacral, homeopathy, therapy, medication, massage, and a dozen other modalities all trying to reconcile her "failure" as a mother to be there to bond with her child. No amount of words can soothe her pain; believe me, I have tried. So I listen, over and over, to her sadness... and I pray she gets unstuck and doesn't treat this child as The Second Coming. Apparently, sometimes, stuck feels better.

I have had numerous discussions with moms after we resuscitate newborns or after the baby was yanked out as it was dying inside mom and was worked on, removed from sight, and worked on more... or babies that are poked and prodded and have gadgets holding their bodies together... or babies who have their spine closed at 2 hours postpartum... or babies who have heart surgery at 1 hour postpartum, never having seen mom or dad... or babies who have their intestines pushed back inside and endure several surgeries to close their guts...

what of all these babies and their psyches?

I know many of these children as infants, children, teens, and now adults... and they are FINE.

It doesn't mean we don't WORK to have peaceful birth. It doesn't mean we ignore their feelings and sensitivities and indiscriminately screw monitor leads into their heads or spank their butts or speak evil of them.

It just means that when we HAVE to, (like my question to Donna about her calling Landen's birth her Perfect Birth... if I'd have had to give her pit or help Landen breathe, would it still have been perfect? Donna says YES because it would have been needed to sustain life), for goodness' sake, we are resilient beings! Our minds work through infinite crisises in our lives... death, pain, moving, divorce, separation from parents, sleeping alone for the first time... the list, as we know, is endless! Perhaps those of us with trauma (and I count myself since Meggie needed to be resuscitated at birth) have assisted our children in a life lesson that might aid them forevermore. Perhaps they CHOSE us so we could give them a part of their walk earlier than later... so they could be strong for something 50 years from their births.

Maybe I am just justifying.

Maybe I work too hard to help women let go of guilt. There is PLENTY to feel guilty about later as they get older. Believe me. It just starts around birth-time. It grows with every passing year.

I believe the true issue is if there is a disconnect with the child after time has passed. Some women do have connection issues (usually surrounding childhood abuse or drug/alcohol issues) and need help learning how to mother/parent. For some, it might be true postpartum depression. These are different than the transient, "Who the hell are you?" that so many women feel.

I hope this helps some. While I really do struggle with the phrase You are not alone because I feel it discounts feelings, I think that if women heard these stories pre-pregnancy and during their pregnancy, it might help women feel less alone.

And who wants to feel alone when we are scared?

Not I.