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Tuesday
Apr082014

Lilia's Birth Story (Brow Presentation)

"I think she'll be born next week," my doctor told me. At 39 weeks and 6 days pregnant, it wasn't what I was hoping to hear. I had stopped working the week before, both my parents had flown in from Hawaii, baby's room was clean and ready, and her newborn-sized onesies washed. My baby was prepared, too. Since week 20-something she had been in a head-down, anterior position.

To my surprise, I woke up the next morning, her due date, with bloody show. Not long after, I began to feel contractions. My husband and I began tracking them at 8:30 a.m. on December 6. At 11 a.m., we called our doctor to let her know they were consistently 10-12 minutes apart. I continued contracting into the afternoon, but life went on as normal. I understood that contractions could stop, so I didn't want to get too excited, but I asked my mom to take some pictures, just in case it was my last day being pregnant.

Around 6 p.m. Dr. G came by to see how I was doing. "You're at 1 cm," she said. "I'll be back later." From the beginning, I loved Dr. G's calm, confident nature. When my husband and I were window shopping for obstetricians, she was the first we met. I found her website when we were just a few weeks pregnant with the search terms "home birth Panama". In a country where the c-section rate in private hospitals is 8/10, I was determined to have a vaginal birth, and it seemed like a home birth was just the ticket. Dr. G was just the person for the job. Actually, she was the only person for the job. She and her husband are the only doctors in Panama who do home births.

At 11 p.m. Dr. G came back. "You're 6.5 cm. I'll set up the pool." I was elated. 6.5! That's practically 7! I'm almost there. When the pool was set up, Dr. G invited me in. I was in darkness, in my daughter's room, contracting in the warm water. The contractions were getting pretty intense. I loved the water, but I wanted to use the bathroom, then go to the bed, then back to the water, then use the bathroom again. In the living room, my mom and Dr. G, along with her husband, talked and looked at family photos. During a particularly intense contraction, I told them to shut up. For the most part, my husband and I were alone in our little girl's room, in the dark, waiting for her to come.

I was camped on the edge of the pool, arms hanging over the side, resting on my knees. When I got the urge to push, I told my husband, who alerted Dr. G. "Push if you want to push," she said. So I did. I pushed when I felt the urge to. I didn't feel like I was making any progress, so I thought that maybe I was misreading my body's cues. Still, I pushed when I felt the urge to. I pushed with my whole body.

Dr. G came to check me and said that there was something preventing me from being fully dilated, and that it was preventing my baby from being able to come down the birth canal. I'm actually not completely sure what she said, as Spanish is my second language and I was in labor, but that's what I understood. She finished breaking my water, which had partially broken while I was on the bed earlier.

Though I was not aware of the time, it seemed hours passed. The sun began to light up the room. "December 7th," I thought, "My daughter's birthday will be December 7th." Dr. G insisted that I drink some juice. "You need energy," she said, "Take a sip." I refused. "Take one sip. Now another. And another. OK, finish the cup now." I didn't want any of it. All I wanted was to finish the job. Dr. G was right, I lacked energy. But I did not lack determination.

Dr. G encouraged me to feel for my baby. "How many knuckles in?" she asked. "Two." After several pushes, we were still at two knuckles. What am I doing wrong, I wondered. I'm doing everything I can.

At the insistence of my mom, my husband Jose got in the pool with me. She had been gently suggesting this for the past half hour, but I did not want to move from hugging the side of the pool. Finally, I gave in. My tired body rested in the arms of my husband, who sat behind me. With each contraction we pushed together, his hands gripping my legs and giving me strength. Soon some black hair emerged. It was at this point that the pain of the contractions were matched by the pain of my daughter's head grinding my tailbone as it curled back inside me post-contraction. I don't know what was worse, the pain during a contraction or after a contraction.

I remember my contractions pausing for some time. When they came back, I pushed with everything I had while my cheerleaders coached me in English and Spanish. I was so caught up in pushing that I hadn't realized the progress that I had made. "Look down," my husband said, "Look at her face!" As soon as I looked down she was already swimming out of me like a little fish. Dr. G got her, unwrapped her umbilical cord from her waist and leg, and handed her to me.

Lilia Marie was born with her eyes wide open at 8:30 a.m. on December 7th. 7 lbs, 2 oz and 19 inches long.

I didn't think much of the unicorn shape of her head then. I knew babies' heads were funny-shaped when born, and I was more taken by her beautiful face, her precious hands, and her full head of hair than the shape of her head.

When Dr. G came back the following day to check on Lilia and me, she mentioned that the obstetrician books say Lilia's type of birth, brow presentation, is not possible vaginally. I didn't understand then what I understand now. The diagram below is helpful. The most common presentation is A. Lilia's brow presentation is illustrated in C.

 

I also did not understand how this would effect my recovery. Supposedly, a benefit of vaginal childbirth is a quicker, more easy recovery. I, however, could not stand up without immense pain for three weeks. It felt like a bulldozer had cleared a tunnel through my body, and when I nursed, I could feel my insides going back together. It was so painful I would often cry. At my six-week check-up an internal wound was still healing, so I was prescribed Sufrexal to help it along. My physical recovery took a toll on me emotionally as well, as I could not hold my daughter in a standing position for the first month of her life, and I felt that I could not adequately comfort her.

Monday
Apr072014

If You Have to Ask...

FACEBOOK!... the answer is TRANSPORT!

That is all.

Monday
Apr072014

Kristen's Uterine Rupture Story

In 2005 I delivered my first child, a son, via emergency c-section due to "non-reassuring tones".  I miscarried my second pregnancy at 10 weeks in 2009.  After infertility treatments, I became pregnant a third time in 2011.  My pregnancy was glorious, healthy, and I felt great throughout.  I was seen by a seasoned midwife at a highly respected practice that delivered at a large suburban hospital. My midwife was pushing for a vbac, but I was on the fence.  I told my midwife that I would not want to attempt a vbac if my baby was over 8 lbs, at which point she reassured me he wasn't (he was actually 9 lbs, 9 oz at birth). I think my instinct was telling me not to vbac, but I was being overwhelmingly told how much better for my baby a vbac would be.  Ultimately, I decided to let God/the Universe decide.  I prayed about it and said if I went into labor prior to Jan. 2, 2012 (the first date the hospital would allow an "elective" c-section due to the March of Dimes 39-week guideline), I would attempt a vbac.  If I did not go into labor prior to Jan. 2, I  decided I would do a RCS. 

My water broke around 1:00 AM on 12-31-11, as I was brushing my teeth before bed.  Because I was Group B Strep positive, we went right to the hospital so antibiotics could be administered.  I labored slowly, and around 7:00 AM began receiving Pitocin.  They continued to increase the amount of Pitocin and I began to have a lot of pain, so around 10:30 AM I asked to have a C/S.  The midwife talked me out of it, saying both the baby and I were doing well, and why would I want an unnecessary surgery.  She suggested I get an epidural and I remember saying, "but if something goes wrong I won't be able to feel it".  She assured me they were doing continual monitoring and all was well.  It will haunt me forever, but I agreed to continue laboring as well as to get the epidural. 

Around 3:30 PM on 12-31-11 is when I believe I ruptured.  I noticed I didn't have one big baby bump anymore, instead I had two smaller ones that were diagonal in my abdomen.  I pointed it out to the nurse but no one seemed worried.  Minutes later, I heard my son's heartbeat slow and not come back up.  My parents had just arrived, and at this point the midwife and several nurses came rushing in, only to realize I was bleeding heavily.  They rushed me to the OR for a c-section, but for reasons still unknown to me, no doctor showed up to perform the c-section for 45 minutes.  During that time, the midwife, nurses, and anesthesiologist simply had to stand there knowing my baby was most likely dead already.  When the doctor did show up, my son was found up in my abdomen, my cervix had also torn, and my catheter was filled with blood as my bladder had also been damaged.  The suction necessary to pull my son out was so strong, it lifted my body off the OR table.  When my son came out, my husband said my body fell back onto the table and I passed out. 

My son was blue and not breathing at birth.  He was resuscitated and put on life support, then sent to a NICU at a trauma center an hour away.  While initially there was some hope we would eventually bring our boy home, sadly his brain damage was too significant.  He went into cardiac arrest at five weeks old, and although he was again resuscitated, he suffered further brain damage and we had to remove his life support so he would not have to suffer anymore.  Of course, after watching my son's incredible suffering, I will always wish I had trusted my instincts and demanded the C/S when my son was still perfectly healthy.  Or refused Pitocin (didn't know then I could have said no), or not taken the epidural...   I am learning to live with the million "what if's" that I now have.

Monday
Apr072014

Anna's Uterine Rupture Story

On Christmas Day, my husband unwrapped my gift - six consecutive boxes to find, eventually,my positive pregnancy test. We were expecting our second baby the following August.  Through that winter, spring and finally summer, I had a perfect pregnancy. Even in the heat of a southernsummer, I loved being pregnant.  

Early on in my pregnancy, I read a newspaper article about a mom who had chosen to give birth at home after a previous c-section.  It sounded so different from the hospital c-section I’d experienced with our daughter who turned breech at 39 weeksThis mom described her birth as “empowering” and her story was so full of emotionWhat a relief it would be not to be separated from my 2 year old daughter and have her welcome her little brother as soon as he was born.  How comforting it would be to walk my own halls – or better yet, the garden – as my contractions progressed.  How nice it would be to not be caught on the hospital conveyer belt of pregnancies, but have a midwife who knew me and my family, attending.  I contacted the midwife mentioned in the story to see if she would be willing to have a patient over an hour away from her practice.  To my surprise she said yes, and our journey began. 

We took our preparations for our son’s birth seriously. We studied pain management techniques, I was active and did weekly yoga.  I found a local doula and signed up for childbirth preparation classes.  We also grappled with days of doubt.  We asked our midwife hard questions about recognizing problems before they became emergencies: How would we know if something wasn’t right? “I’ll know” she assured usAnd as a Certified Nurse Midwife with 10 years of hospital experience, as well as experience with hbacs, I expected her to know what she was doing, how to manage the risks and when to transfer to the hospital.

Finally, at 40 weeks and 2 days, we thought Christmas had finally arrived.  I woke up at 1am in intense pain, but figured I should try and rest for as long as I could.  There was no resting.  I called my midwife, barely able to talk through my contractions.  She was at another labor, but promised to send another midwife from her practice.  My nerves kicked in - this was not what we had planned. I remembered my husband predicting the midwife would not be there for us when I went into labor on the long drive up to one of the many appointments she had cancelled.

The sun rose.  The alternate midwife arrived.  The pain increased. I couldn’t move, I couldn’t breathe, I couldn’t focus and around 7am said I needed a break.  I knew that was supposed to be a sign that my labor was transitioning, but I also knew that the pain I was experiencing did not feel like the pressure I expected; it was too raw.  I did not feel empowered, I felt vulnerable.  Nothing about this was “beautiful” or “healing.”  Hours had passed.  The water in the birthing pool had been warmed up again and again but was no longer offering much comfort. expressed my concern that I was experiencing the “wrong kind of pain.”  There was a strange popping sensation. The midwife had no answers for us.  My husband noticed that my abdomen looked asymmetrical and pulled our midwife aside to express his concern about my pain.  The midwife said everything was normal; he continued to encourage me accordingly.  For hours.  

I remember seeing a hummingbird at the window, hovering, curious over the roses my husband had put in the window for meThen, in one contraction my whole body suddenly felt like it was tearing apart. I thought my son was descending; in reality it was my uterus rupturingMy midwife tried to check my son’s heartbeat.  I could hear the faint dull, slow, thud.  60 beats per minute when it had been in the 130s.  And then the vomiting and shaking started.  I closed my eyes and did not open them – willing the world to go away.

After eight hours of labor there was nothing my midwife could do to save our son.  There was no operating room in my kitchen.  She only had a pediatric oxygen maskWe put in a 911 callimmediately but even with the EMS arriving within 10 minutes it was a further 15 before they had managed to get an IV in and we were even on the move to the hospital, each bump in the road causing all-consuming ripping pain.

By the time we reached the hospital by ambulance – under 8 miles away  Brody had no heart beat.  He was gone.  I prefer to think that he died when I felt him struggle upwards out of my uterus while we were still at home, than in the ambulance to the sound of my screams to get him out.  

I am lucky to be here after the volume of blood I lost.  Without the rapid transfer I would have bled out.  When my surgeon performed the emergency c-section I needed to deliver my dead baby even he was shocked.  My uterus was – in his words – shredded.  Brody was lodgedagainst my liver.  I had insufficient blood volume for anything other than general anaesthesia to work.

I will always regret the gamble I took with our son’s life.  If I had been in a hospital, continuous monitoring could have shown that Brody was experiencing trauma; that my contractions were not the right intensity given the pain I was experiencing; and my rupture might have been caught early enough to have given our son a fighting chance of survival.  Aultrasound later in my pregnancy would also have shown he was going to be big – 9lb 2oz – rather than the 7lb my midwives guesstimated.  An obstetrician might have raised concerns about the short time, just 10months, between my pregnancies, and warned me of the risks involved with being too far from an OR.  There’s a reason ACOG’s guidelines recommend hospitals who allow vbacs have an OR available and staffed 24 hours, 7 days a week.  I had come to believe in “trusting birth” and “trusting my body.”  But my body broke.

If we had been in a hospital I would probably not tell myself every day that not only did my choice to give birth at home result in the death of my baby, it deprived my husband of the gift of a first son, and took away my daughter’s chance to have the little brother she now asks to go rescue from heaven in a rocket ship.  We all want him back.

In one out of every two hundred vaginal births after caesarean, the mother ruptures.  But, I had a perfect pregnancy – why would I be that one?  The bigger risk – surely – was “unnecessary interventions” inevitably leading to a repeat c-section.  I did not know how quickly my baby could die.  I did not know that the hospital would be too far away to save Brody.  I did not know that I was gambling on my son’s life for the sake of an idyllic birth at home.  

I know there are lots of stories of mothers who have had a great experience birthing at home.  They were very, very fortunateI need you to hear my story: parents who suffer tragic HBACoutcomes do not tend to speak out because we know it was our choice. But, the absence of their voice should not give you the false impression that heartbreaking experiences like ours don’t happen.  They do.

My medical records state “13:15 client stable, holding baby”.  My warm, pink, perfect baby who quickly began to turn blue.  I stroked his soft cheek, willing him to come alive in my arms as thetears fell on his closed eyelids.  There was no magical fairytale ending to break the curse.  No true love’s kiss could make him breathe and let me look into his eyes.  My hummingbird had flown.  We love you Brody, I’m so sorry I let you down.  xxxx

“i carry your heart with me (i carry it in my heart).”  ee. cummings

Monday
Apr072014

K's Uterine Rupture Story

I had my son by C-section in 2006.  Joey was a little giant, 10 lbs. 2 oz.  Reason for the section was shoulder dystocia and cord prolapse.  My recovery was pretty uneventful, but I still thought that if we had another child, I’d like to try for a VBAC. 

I had several miscarriages between the births of my children, and consulted a reproductive endocrinologist at the University of Iowa (we lived about 45 minutes away from there in a small town called North Liberty.)  One of the tests I underwent was an ultrasound to check if my C-section scar was a contributing factor.  It looked good, so good that the tech called it “the most beautiful scar she ever saw”.

They found that the reason I kept miscarrying was most likely due to low progesterone levels, not anything as a result of my section (the only other uterine procedure I had was a D&C because of a miscarriage).  I was given the go ahead to try one more time.

I got pregnant with my daughter in the summer of 2009.  My doctors carefully went over my file and told me that they thought I would be a good candidate for a VBAC if I wanted one.  Even though I had a difficult pregnancy (I had lost Victoria’s twin at 8 weeks, she had been diagnosed with a congenital heart defect at 20 weeks, and I had gestational diabetes that was difficult to control satisfactorily, even with insulin), they still offered me the chance to attempt a VBAC at the University Hospital, based on that ultrasound report about my scar and their opinion that it was highly unlikely that I would have another child with cord prolapse.

We scheduled a C-section for March 7, in case I didn’t go into labor naturally, so we could have the NICU ready for my daughter’s needs.  I went into labor naturally, however, on the evening of the 4th.  I stayed at home until my contractions were about 5 minutes apart, then we headed to the hospital.

My doctors had told me that they were not going to give me Pitocin, which was fine with me.  They told me that it could increase the chance of rupture.  Before I could get an epidural, they had me sign a bunch of paperwork.  I remember one of the sheets talked about uterine rupture, but said the risk was small.  They would not let me proceed with a VBAC unless I signed it, so I did.  And I waited.

I got moved to a primo spot (I could see the football stadium from my room’s window ~ which is a huge deal to UI fans.)  I quickly progressed from 3 cm to 8, then to 9.  We expected her to come any moment.

Then we stalled out.  I was stuck at 9.5.  Breaking my water didn’t help.  I asked my doctor for one more hour, but had no progress.   We agreed to wheel me down to the OR for a repeat C-section.  We were all pretty tired, and we wanted to finally meet this little girl.

At first it went pretty much like my first C-section had.  There was a light mood in the OR.  We told them what her name was going to be, we waited a bit for the NICU staff to arrive (so they could get their first really good look at her heart), and we waited for my husband to get suited up.  The doctor said she was making the incision, and there was happy chit chat.

Then about two minutes later, it went silent.  I looked at my husband.  He didn’t seem to know what happened either, but when we looked at the doctors and nurses they all looked pale.

My doctor spoke first.  Clipped tones, slightly louder voice, no nonsense, precise Indian accent. All business.  Everyone moved quietly, efficiently.

My baby girl was lifted high for me and my husband to see.  “She’s beautiful” my doctor said, then handed her off to the NICU staff.  Still no talking, other than a call for a certain clamp or other surgical instrument.

Me and my husband knew something was wrong.  No idea what, though.  It had to be bad.  Everyone in the room was pale and holding their breath but us. 

Then someone said the word “rupture”.

I looked at my husband.   English is not his native language, but he understood it before I did.  I have never seen him look that scared before.  I hope I never do again.

Oh shit, I thought, as it slowly sunk in.   Was that the only glimpse I was going to get of my daughter?  She was….is….beautiful. 

Someone asked my husband if he wanted to go to the NICU with Victoria.  I told him to go.  He refused.  I then ordered him out, and said she needed him more.  (Actually, I thought there was a good chance I was going to die and I didn’t want him to witness that.)  He reluctantly left.  I wasn’t sure if I was ever going to see him again.

The doctors continued to work.  I started silently praying, and occasionally dry heaving.  I started shivering so hard my teeth chattered, and was beyond grateful when they brought me a warm blanket.  On occasion the anesthesiologist asked me if I could feel any pain.  I couldn’t.  I did feel sleepy, though, and fought to stay awake.  I was scared to close my eyes.  I knew as long as I was awake I was alive.

I heard someone talk about my ureter.  I guess I looked confused, because the anesthesiologist told me that they wanted to be sure it was not cut while they were putting me back together. I wasn’t going anywhere until they were sure it was working correctly.

It was.  I saw some color creeping back into the doctors’ and nurses’ faces.  Someone said “closing up.”  The anesthesiologist told me I would be feeling some pressure.  I kept visualizing my guts being stuffed back inside me.  Someone told me that they were able to save my uterus.  I wasn’t going to die, after all.

When my daughter was delivered, I looked at the clock over my doctor’s shoulder.  She was born about 5 pm.  It was now closing in on 7.  Two hours of this.  I couldn’t believe it.

Finally, the doctor left the room, and I felt my gurney backing up.  They were wheeling me out of there.  There must have been ten doctors and nurses coming along with me to my first recovery room, just off the OR.  I guess I started to feel a little giddy then.  Couldn’t believe I came that close, and was still here.  I’d get to see my husband, my daughter and my son again.

I arrived at the first recovery room.  Had a nurse standing by, with what looked like six flat screens.  She was supposedly tracking other patients in there.  I noticed she kept asking me about my family, and my life, and other little chit-chat questions.  I guess all my signs looked good, and an hour later I was sent to the regular maternity ward.

First time I was alone in hours. 

I started wondering what the hell just happened to me, and was my baby ok.  I was exhausted and finally passed out for a bit.

I heard a nurse come in, and I asked her about Victoria.  She was fine, she said, and asked me if I wanted to see her.  YES!!!

They found someone to push my wheelchair over to the NICU.  I know I looked like hell, and even being wheeled over was tiring.  But I got to see her around midnight.  She still looked beautiful, and they got her out of her bassinet so I could hold her.  We made it.  Thank God.

The next morning, the nurse got me up to use a walker.  I remembered that from my first C-section.  I dragged myself down the hall, and would have tried to make it back to the NICU if I wouldn’t have been so wiped out.
Then, the first pair of doctors visited me while I had breakfast.  They were two women, in their late 20’s.  One brunette, one blonde.   They were the first to tell me just how badly I ripped apart. 

The blonde doctor told me that the OB was just about to start the incision into my uterus when she watched it split apart before her eyes.  I tore all the way into my vagina.  When I asked about my original C-section scar, she said that held together.  Everything else fell apart. 

Then the brunette doctor spoke.  They were able to save my uterus, but I should never think about having another child.  She said that it was highly unlikely I could carry another baby to term.  Any attempt would likely kill us both.  They could not guarantee that I would pull through a second time.

We had already decided that Victoria would be our last child, but hearing that was hard to take.  I know that doesn’t make a lot of sense.  Maybe it is because it wasn’t just me and my husband making the decision any more, but my body hitting the limit of its capabilities. 

I got a variation of that second doctor’s speech about five more times before I was discharged four days later. 

The doctor who saved my life was able to answer a few more questions when she checked in on me.  Maybe her soft Indian accent made it easier to take.  She said the walls of my uterus were paper thin, and we were lucky that they held as long as they did.  I had lost two liters of blood before she could stanch the bleeding.  She had been practicing since the late 70’s, and I was the third rupture she had witnessed.

I didn’t have enough guts to ask her what happened to the other two women, or their babies.  I hope they made it through, too. 

For the next few months, I concentrated on getting my daughter prepared for her corrective open heart surgery.  She was born with Tetralogy of Fallot, and surprisingly the whole ordeal of her birth didn’t affect her one bit.  (She’s now a beautiful little four year old imp who loves torturing her older brother, dancing, swimming, ice skating and Hello Kitty.) 

I didn’t deal with the rupture until my daughter was almost a year old.  By then, she had recovered from her surgery with flying colors, we had moved from Iowa to Florida, and life was starting to settle down a bit.

I started to look up things about uterine rupture and   came across some survivor groups.  I’ve never met anyone in real life who had a uterine rupture, so they’ve been a source of comfort.  I stopped feeling like such a freak of nature knowing there’s other people out there like me and my family.

I’ll never be completely over it.  I can’t help but think about it whenever my daughter’s birthday rolls around, for example.  I can’t help reliving at least part of that day.  I dread the day when she innocently asks me what it was like when she was born….”was it a happy day, Mommy?”

Sometimes it hits me at random moments.  Just recently, when I was at Publix, I picked up a bottle of wine.  750 ml., average size.  For some reason, I put two more next to it in the cart and said, “That’s how much blood I lost that day.”  I sat and stared at it for a while.  Couldn’t believe I could lose that much, not have a transfusion, and still drag myself down a hallway the next day.

My husband still tears up and says he thought I was going to die and leave him a widower.  He only recently told me that while he was waiting to hear if I would make it, he was wondering how he would raise two small children alone.
No one ever tells you that uterine rupture affects men, too.  How could it not?  They watched the mother of their child almost die; maybe they witnessed their child’s death.  I worked with men, and know how they always want to “fix” things.  This is something that they can’t fix, possibly the first thing they can’t do one damn thing about.  I know women who would try again, but their partners just refuse.  They don’t want to take that risk.  Their hearts can’t take it.


One of the hardest things to accept is how many of the women in the survivor groups shouldn’t be there.  Most of them were in better shape than I was.  They had healthier pregnancies, they were younger (I was 41 when Victoria was born), their children had nothing wrong with them (or at least, nothing as serious as V’s heart condition).  I had a c section, and several of them did not.  Yet their children were taken, and my daughter wasn’t.  I still can’t make sense of that.

I didn’t think when I signed the paperwork that I would be that 0.5% they were talking about.  I had no idea how I would freak out over a late period, and start worrying about possibly being pregnant (After all, maybe I’m in that 1% of women who get a tubal ligation and it doesn’t work?).  I still have no idea how I’m going to address my daughter’s questions about her birth.  What if my daughter, or future daughter in law, is trying to decide if a VBAC is the right choice for her?  (I still think it’s a great option, but damn straight I start worrying like crazy when a friend of mine attempts one.)  How do you explain that you are happy when other survivors find your group, but you wish there weren’t so many of you in it?


This is why I get angry when I see some half-wit post that uterine rupture is overblown.  If you are only concentrating on the number of women who experience it, yes….it’s statistically small.  But the effects on the families who experience it are huge, even if everyone pulls through.  Shouldn’t that factor into the discussion, too?

I post a little about my story from time to time, usually when a post about HBAC (or UBAC) comes to my attention.  I say that a VBAC at a properly equipped hospital is an excellent choice, please reconsider your plans for something other than that. 

I get one of two reactions.  Either I’m ignored, or someone calls me a fear-mongerer.  I’m not.  I’m the best case scenario.  I pulled through, my daughter did too, and physically, I’m ok.  I have a talented doctor, a first rate surgical team and a properly equipped hospital to thank for that.  I practiced what I preach, and that’s why I’m here to talk about it.

I’ve not only heard the stories of women who tried HBAC and/or UBAC and fell on the wrong side of that percentage, I know their names and the names of the ones they lost or left behind.  They aren’t mere statistics to me.  They’re beautiful, brave women and beloved children.  They were someone’s everything. 

You don’t want to join our club, and we really don’t want more members in it.  That’s why I speak up.

Monday
Apr072014

Uterine Rupture Birth Stories

It’s very difficult to find uterine rupture (UR) birth stories. The moms who have them say they are shuffled off into the dark side of the Internet where they huddle together in isolation from the support they’d once had when they were pregnant. Told they need to go to Loss Groups, they are left almost alone in their grief. 

I’ve decided, after talking to several of these moms, that enough is enough. Their birth stories deserve to be heard, even if they ended in tragedy. And not all did, thank goodness, but enough have that it will surely make the reader uncomfortable and sad going through the stories. 

I am pro-Vaginal Birth After Cesarean (VBAC) and pro-Home Birth After Cesarean (HBAC). I get a little more woogily when it comes to Vaginal Births After Multiple Cesareans (VBAmC), but do support them if they are done in the hospital. 

I believe in order to do a VBAC, the client needs to have a very skilled and experienced provider, one that knows the signs of UR in its beginning stages. These are fetal heart tones going down with or without uterine contractions, the uterus looking divided, the baby crawling up in the uterus, pain in the mother, not necessarily over the scar, a mother’s feeling of panic or fear, her blood pressure crashing and finally, and the least likely to be seen first, is bleeding. The blood doesn’t often come until the abdomen is opened during a cesarean. 

URs are rare, but are, as far as I can tell, happening more and more. Whether that’s because there are more women wanting to VBAC or because the cesarean rate is also climbing, I don’t know. Maybe I’m just hearing about them more. I’ve only seen two URs and both were in primip(aras –first time moms) when they were given too much Pitocin. I’ve never seen a UR in a VBAC mom. I know midwives that have, however, and they become skittish about attending VBACs ever-after. I wonder what I would have done as a home birth midwife if I’d have had a client experience a UR. Would I have stopped attending them at home? I often say that a midwife is a product of her experience, so very well could have stopped servicing HBAC moms and only doulaing them in the hospital. 

I’ve attended about 40 VBACs in the hospital, about 20 in birth centers and about 15 HBACs. I’ve attended VBAmCs in the birth centers, but none at home. The most previous cesareans a woman had was four, VBA4C and there were two of them at the birth center I was at in El Paso many years ago. I doubt they would do that again today. 

Concurrently being published is a piece by Dani Repp at “What Ifs and Fears Are Welcome.” She wrote a post regarding the risks and benefits of VBAC, Elective Repeat Cesarean Delivery and HBAC. I took part in the Q&A on the post and you can read it here

If any of you need more information or support from UR moms, you can contact me and I can put you in touch with a Facebook group or a UR mom.

Tuesday
Mar042014

A Baby Died

A baby died.

Several of us watched it happen on Facebook. I came into the conversation right after the death of the baby. On Jan Tritten’s Facebook Page, a midwife “crowdsourced” (asked a question of the masses) the following scenario:

“What would you do? Primip with accurate dates to within a few days who has reassuring NST at 42.1 weeks, as well as reassuring placenta and baby on BPP, but absolutely zero fluid seen. 42.2 re-do of BPP and again, mom has hydrated well, but no fluid seen. Baby’s kidneys visualized and normal, and baby’s bladder contained a normal amount of urine. We’re in a state of full autonomy for midwives and no transfer of care regulations after 42 weeks. Absolutely no fluid seen…what do we truly feel are the risks compared to a woman whose water has been briken and so baby/cord has no cushion there either. Cord compression only? True possibility of placenta being done although it looks good? Can anyone share stories/opinions? Technology isn’t perfect and I like Gloria Lemay’s visualization of a glass tub above you…how much water will you actually see below someone in the bathtub? But, my hands feel nothing but baby (who again…is doing well and recovers well after spordic contractions). Mom feels everything is fine and wants to leave things alone.” (Quoted verbatim with spaces and misspelling intact.)

Some commenters (some of whom are midwives) were unbelievable with their recommendations that ran the gamut from homeopathy to Stevia to cell salts. It was a debacle that unfolded real time on Facebook and, sadly, it ended in the death of the baby.

“Very sad news on this baby: The baby didn’t make it. Had aspirated meconium a while back they believe. Even after another BPP that showed everything was fine today. I listened to the baby afterwards and heart rate was on the low side. We came in, chose a c-section, and they worked on the baby for 47 minutes.”

You can read the entire thread here.

Instead of expressing horror, several women wrote sympathy comments for the midwife and expressing that, sad as it is, some babies just die.

This baby did not have to die.

Questions that have arisen include: Who did the Biophysical Profile and said it was fine with no amniotic fluid? Was the mom on the fetal monitor for at least 30 minutes in order to get the BPP accurately? Who was the doctor and why did s/he say it was okay to keep going with the pregnancy when there was no fluid? Was there a doctor looking at the BPP?

In other places, it has been said this wasn’t the whole story. That the woman was being followed by a doctor as well as the midwife. That the midwife did an NST in the car after the BPP and that’s when she found the fetal heart tones going down. (An NST cannot be done with a doppler even though it is, in my experience, a standard of care for home birth midwives.) That the midwife tried and tried to get the client to the hospital for an induction. However, what sounds like a letter to the parents, the midwife says, among many things:

“Instead of … telling you to “be prepared that the perinatologist doing the NST is likely to tell you that your baby could die if he doesn’t come out;” those should have been MY words. You might have been really pissed at me for pushing you into a corner where you felt you didn’t have a choice, but … I wouldn’t care… I am angry at myself for being the midwife who tried to be as firm but gentle as possible when advising to go in when I could’ve waved the dead baby flag…”

There is a problem with midwives not wanting to be The Bad Guy with pushing women to go into the hospital. Doctors tell women bad news all the time and can’t take it personally. But, midwives take pride in becoming friends with their clients and don’t want to hurt anyone’s feelings. Look what that attitude did.

There was an assumption of who the midwife was, but I didn’t want to say until there was proof. Today, in Dr. Amy’s piece called “In Memory of Gavin Michael” the baby’s grandfather verified the midwife was Christy Collins in Las Vegas, Nevada. I have offered Christy a forum for sharing her side of the story, but have not heard back from her yet.

What more do I have to say about this that hasn’t already been said? I hope midwives around the country, specifically CPMs/LMs will take this lesson and learn from it.

First, don’t ask for advice on the Internet! If you feel you need to, then you are working outside your scope of practice – transfer care! Plus, there are HIPAA violations abounding.

Second, going post-dates has consequences. It isn’t as benign as you think it is. There’s a reason so many protocols force a referral for post-42-week pregnancies. All the anecdotes of babies over 42 weeks are terrifying. That one midwife let a woman go 19 days post-dates (and bragged about it!) is abhorrent.

Third, it’s important to start your NSTs at 41.3 weeks and then progress every two to three days after that. Starting later doesn’t offer a good baseline and isn’t good midwifery. BPPs should start in the 41st week and progress twice a week at least. Again, a baseline is important to have.

Fourth, when a midwife loses a baby, don’t just assume she’s in the right. You have to look at the whole picture (which, admittedly, we still don’t have yet… that will probably come out in court) and give the benefit of the doubt to her being wrong, too. We do make mistakes and we must look at them to see what we would do differently.

Fifth, when you are considering doing something outside your comfort zone or that is unusual, think, “What will this look like in court?” or more directly, “How will this look on the Internet?” If you are comfortable with your decision, then proceed. If it will look damning in court, reconsider moving forward.

Sixth, if you get a client that doesn't want to do what you suggest, DOCUMENT IT!

Lastly, Dr. Amy is no longer the enemy. While I disagree with many of her styles of communication and don’t consider her a friend, the parents are going to her and we can no longer ignore her or her website as the truth about these cases comes to light on her pages. By doing so, we are sticking our heads in the sand and, as she calls it, burying the baby a second time – first in the grave and the second by ignoring the death and circling the wagons around the midwife, protecting her from any questions or investigation about the death.

Let’s not forget Gavin Michael.

Friday
Jan312014

My Take on the MANA Stats "Study"

I am not a Statistician so cannot speak about the stats in the study. What I can speak about is how the statistics were gathered and what that might mean about the whole study’s validity. 

My own statistics are a part of this study. I have filled out the paperwork not only for myself, but for other midwives as well. In fact, I have spent hours filling out the statistics paperwork, poring through charts, answering questions from the beginning of pregnancy through six weeks postpartum. 

The study says they enrolled the clients before they knew the outcome of the births, but I beg to differ. They may do that now, but back when I was doing them (2004-2009), we didn’t even fill out the paperwork until the woman was past six weeks postpartum. In fact, we used to sit with a pile of charts in our laps and fill out stat sheet after stat sheet, some women even a year (or more) postpartum. At that time, the stats were filled out on paper and sent in, so I know we weren’t supposed to send in any statistics before the woman was six weeks postpartum. I can’t imagine we were the only ones that did it that way. 

So, while there are parts of the statistics that are objective – whether the woman has a breech baby, twins or was a transport – there are other aspects where the answers to the questions are subjective. How long a woman’s labor was, how long she had Rupture of Membranes, the degree of her tear… are all areas where subjectivity come into play. You wouldn’t think so, but I have seen midwives lie in the chart (and then on the stats forms) about such things, not wanting the Powers That Be to know they let a woman with ROM labor for 32 hours without transferring her or that she sutured a third degree tear. I never saw charts be subjective when I worked with the CNMs in the two birth centers I worked at, but it was a distinct part of the midwifery culture I worked in as a CPM/LM. I know I stretched the truth myself when it came to extra long labors or trying to get the best blood pressure on a woman. 

As we know, the statistics gathering was completely voluntary. I knew several midwives who never did the stats; a few that did. And this was just in one city! How can anything really be known by such skewed statistics (if you even want to call them that anymore)? And I am sure that midwives with a bad outcome just didn’t finish that woman’s stats. It would have been encouraged in the culture. So that so many did send in negative outcomes lets us know how bad the perinatal mortality and morbidity rate really was. 

I look forward to more dissecting of the perinatal mortality part of the statistics being done. They don’t look good now. That so many are just taking what pro-home birth sites have to say about the study is frustrating. Look at the naysayers, too. 

I know it sounds like I am anti-home birth now, but there is nothing like that at all. I am still pro-home birth… with a highly trained and skilled midwife with a transport plan in place and supportive back up care. I am against breeches and twins at home births (as the study distinctly says should not happen at home!) and am slowly coming to see that even VBACs might not be best to do at home (after talking to HBAC loss moms). But, I do still believe in home births, just with some caveats. 

I, more than anyone else, would love to see a real study telling us about the safety of home birth, but this one sure is not it.

Friday
Jul052013

My Hernia

I don’t know what I did to get the hernia, but when it did its thing, it hurt like crap. A hernia is when a piece of bowel or intestine juts through the abdominal muscle. It can be an emergency situation if the hole strangulates the intestine, requiring immediate surgery lest the person die from the experience. Pain usually drives the patient to the hospital, though, so death doesn’t often occur here in our part of the world. My own hernia was protruding. I could feel it through my abdominal wall, but I read to try and get it back inside the hole so I laid far back in the recliner while massaging the hernia to try and get it back in. Luckily for me, it did go back in. Thereafter, I was extremely careful about lifting or straining, waiting for the appointment to see the surgeon (it had to be approved, of course) and then waiting for surgery. All told, it took four months from the discovery of the hernia to surgery.

I just had surgery three weeks ago. It was laparoscopic, thank goodness, but still hurt like crazy afterwards. Apparently, I had FOUR hernias tucked in there. The mesh protection the doctor was going to use had to be exchanged for a much larger mesh to cover all the holes. Blessedly, I don’t feel the mesh inside… the doc said many people can feel it for three to four months afterwards, until the staples disappear.

I have to do nothing for eight weeks. I can’t do so much as a crunch lest I cause the mesh to break off or give myself new hernias. I asked if there was anytime I could try and work my abs and she said after eight weeks. My abdominal muscles feel shot; I can’t even hold my gut in properly! I look forward to being able to do something in five more weeks.

Who knew hernia surgery would be so limiting? I certainly didn’t.

In the meantime, I’m watching tons of tv and reading when I can focus (pain meds don’t allow lots of focus time). Things are better each day, but I am sure looking forward to doing something with my body after all of this. I think I want to go swimming again. I miss the water.

I just hope that with new movements I don’t give myself any more hernias. I don’t want to go through this again.

Thursday
Jun132013

Guest Post: 5 Reasons to Invest in Babywearing

Babywearing is the act of carrying your child around with you for great amount of time while being comfortable doing so. Some parents view this as an excess of attention. However, babywearing can have a great deal of personal and sociological practicality. There are many reasons why babywearing is an ideal form of raising your child, none of which has implications towards spoiling. In fact, babywearing can be greatly beneficial to solidifying the link between yourself and your child.

1. Comfort - From the moment the child exits the womb, he or she is going to need constant reassurance that everything is OK. This is a new world to him or her and having the presence of your body against the child's can help alleviate anxiety he or she may be experiencing. Since every circumstance is a new experience, the child needs that confirmation that you are present and will protect him or her from harm.

2. Ease of Feeding - For those who have babywearing clothing, breast feeding in a public place is so subtle that no one even realizes what is going on. Without having to fight straps or ties, you can cover your child while he or she feeds under the protection of a babywearing satchel. Since these are wrapped around your shoulders, your hands are free to go about your business while providing the support your baby needs. It's like having an extra set of hands holding your child.

3. Ease of Mind - There is a great relief of stress when you feel the weight of your child pressed against your body. Not only is it calming for your child, but it helps you calm down as well knowing your child is safe and secure. Some mothers have even mentioned how babywearing has eased some of the tension from separation anxiety. Children are not the only ones who can become anxious when away from the parent.

4. Less Fussy - Children that are snuggled against their mothers are inherently less fussy. This can be a benefit for instances while in public places such as movie theaters or restaurants. The less fussy your child is, the more everyone enjoys the situation. Although you may still need to cut the movie a bit short in order to deal with a dirty diaper, breast feeding during the movie or simply holding your child isn't as burdensome physically as it would be otherwise.

5. Hands-free - Being hands free whether you're in public or at home is a blessing to many parents. Babywearing can allow you to continue with most of your day-to-day activities without having to stop and care for your child. Although it may sound like it's a bit of a lazy approach to parenting, you are providing your child with the safety of being close to you while being able to complete various tasks.

You don't have to carry your child around with you until he or she is old enough to drive. However, the additional attention when he or she is between the infant and toddler stage can greatly improve the bond that many parents would be jealous over. As there are many ways you can carry a child in this fashion, comfort for yourself is not an issue. Isn't the prospect of starting off your relationship with your child strong a reason to investigate the possibility of babywearing?

Author Bio:

Rachel is an ex-babysitting pro as well as a professional writer and blogger. She is a graduate from Iowa State University and currently writes for www.babysitting.net. She welcomes questions/comments which can be sent to rachelthomas.author @ gmail.com.

Sunday
May262013

Colonization

I read a piece called “Cesarean Birth Linked to Childhood Obesity” that discussed the baby being introduced to the mom’s good bacteria as he is being born through the mom’s vagina. Theories about allergies, Type I Diabetes, and Celiac Disease have all been implicated in children not receiving their mother’s colonization from their good bacteria when going through the vagina.

Another a June 2012 study offers a detailed look at the early stages of the body's colonization by microbes. Babies born vaginally were colonized predominantly by Lactobacillus, whereas cesarean delivery babies were colonized by a mixture of potentially pathogenic bacteria typically found on the skin and in hospitals, such as Staphylococcus and Acinetobacter, suggesting babies born by CD were colonized with skin flora in lieu of traditionally vaginal type of bacterium.

There’s so much science here, I’m just going to leave it to the researchers. I know they are studying it, they are pcking apart vaginal and cesarean births, I suspect they are taking the different modes of transportation apart (via the nose, mouth, eyes, ears or a combo of any of the methods). I’m just wondering what we do know about it?

Do we add lines in our birth plans that ask for a swab of vaginal fluid if we have a cesarean so we can run it on our breast for our baby to colonize with it? I would ask for a large swab, not a q-tip sized one). Today it seems kind of gross smearing our juices on our breasts and the laying the baby on there to nuzzle. But, I don’t see it being too far in the future when it becomes the standard of care. Might we take a cloth and schmear it down the woman’s whoo haa and then rub on  the baby’s face and then clean the face off. Any of these ways seem doable to colonize the baby.

Is this far in our future? Already I hear about CMNs who swab for the mom and know that women ask for the ability to colonize their babies. Would I be doing this if it were me or Meghann? Absolutely.

What are your thoughts about this controversial experience with colonization?

Sunday
May192013

Oubli's Vaginal Tear

I was asked to share a different kind of birth scar story, different than the usual cesarean scar stories I share here. I welcomed her re-telling of her birth... and share it here with you all.

My Birth Scar

My pregnancy and birth were uneventful medically, textbook in every way - except the tear. In the standard lithotomy position in a hospital with a CNM guarding my perineum, my labia minora split horizontally in two as my child entered the world.

Cue the inept stitch work from a CNM who had too many patients and was in a huge hurry. Not enough stitches were used and days after I was discharge the too few that were there snapped while ambulating. Suffice it to say my labia didn't heal correctly, it didn't heal together, two pieces of flesh cleaving and fusing as it should have. A trip back to the CNM the next day and I was told, "There's nothing we can do, it's a purely cosmetic issue now - deal with it, you are wasting our time unless it's infected."

I hate my wound, for a long time I couldn't bear to look at it or touch it. It makes sex less enjoyable and sometimes uncomfortable (the skin flaps get grabbed by my DH and pulled inside during thrusting) and gynea exams just aren't as much fun as they used to be *snark*.

I call it a wound because I am still wounded by it, although it has healed. To add insult to injury I cannot get it repaired until after I am done child bearing, as plastic surgery on that delicate area has the same risks as Female Genital Mutilation.

Here's why I feel I need to be done childbearing beforehand - "[I]n nursing school I helped out at the delivery of a woman who'd had labiaplasty several years before, and holy shit. It sort of, um, shredded. One of the most horrific things I've seen in my career. It took them a really long time to sew everything back together, and I have a feeling she would have happily gone back to some slightly asymmetric or (gasp!) flappy labia if she could have."

http://jezebel.com/5402091/report-vaginal-plastic-surgery-has-same-risks-as-fgm

Other sources about vaginal rejuvenation or vaginoplasty, includes info about labiaplasties.

http://news.bbc.co.uk/2/hi/health/8352711.stm

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Gynecologic%20Practice/co378.pdf?dmc=1&ts=20121129T0006283149

I fear that if I get it fixed before I am done child bearing it won't stretch properly, as scar tissue is inelastic and it may pop again creating a far more terrible tear in the same place. Even if I do not get it repaired I still worry about it tearing in the same place and becoming a vaginal wall tear. I never feared child birth before but this tear makes me rethink having more children.

4 years after the the initial tearing, it's hard to watch my birth video because of it, I resent my midwife for the lithotomy position, I resent my daughter (a bit) for causing it, I can't masturbate or have sex without touching/thinking about it (usually negatively), when I shave I have to be extra careful not to nick it as it protrudes further than the other side. Oh an did I mention that my stitches didn't completely dissolve, every few months I feel like I'm being stabbed from the inside out as bits of stitch work make their way to the surface and have to be delicately removed. I used to think my vulva was gorgeous and now it looks and feels sad all the time. My scar is still very much a wound that hasn't healed.

Sunday
May192013

How to Choose a Birth Doula

There are as many kinds of doulas as there are women who want one, so deciding how to choose one can really come down to personality. But, might there be other aspects of doula-dom that aren’t so individualistic? 

Education

It should be a given that your doula has taken a training course of some kind. I am not of the school that believes a certification makes a great doula (I am not a certified doula, either), but definitely a weekend workshop should have been had. Whether it’s DONA, CAPPA, toLabor or any of the other groups one might find (Radical Doula has a great list here), attending a training will have been infinitely helpful to your doula.

Experience

This doesn’t necessarily have to be hands-on experience since some of the best doulas I’ve met have been newbies, but there is a great deal of information out there that women can learn via books and videos. They can also learn at meetings where doulas gather to talk about cases. Watching videos of doulas, she can see what makes a good doula, how the woman touches the laboring mom, what kinds of suggestions she makes to her as the labor progresses and how to move about the room unobtrusively. I talk more about experience below in Referrals. Ask your doula-to-be how she’s come by her experience and these might be some of her answers.

Knowledge

This doesn’t have to be just book knowledge, but books cannot be overlooked when a doula is educating herself. What the doula reads and assimilates can help her practice immensely. Much of what I think a doula could do to up her knowledge is to read midwifery texts. Reading Heart & Hands and Ina May’s Guide to Childbirth are two really good books to read to get a feel for the rhythm of labor and delivery. The Birth Partner and The Ultimate “How to” Guide for Doulas are great doula books to read. I haven’t read Experienced Doula: Advanced Skills for Hospital Doulas, but the Amazon comments seem to recommend it. If it lives up to the title, it should be a good one.

Referrals

How do you know how the doula’s going to be interacting with the hospital staff? How will you know until you are in the throes of labor? The best way is through recommendations. This, of course, would mean your doula is experienced. This won’t work if your doula is brand new. But, not to knock new doulas (who might be awesome out of the gate), but I would really encourage at least a little bit of experience before venturing into a doula-client relationship. The question becomes, how can a doula get experience if women only hired experienced doulas? Most doulas start out helping friends and family, not being hired outright by strangers, so developing clientele, even if it is friends and family, is a great way to garner the recommendations she will need. This is sure to be my most controversial advice, but I do stick by getting referrals as a way to learn how a doula acts in labor and birth. You still might come up against a doula that isn’t a good fit in labor, but the likelihood would be less. How a doula interacts with the hospital staff can mean the difference between an awesome birth and a train wreck, so recommendations can’t be taken casually.

Asking the Right Questions

Knowing what kind of doula you want will help you here. Are you looking for a motherly-type doula? Or a take-charge doula? Do you want a doula to tell you what to do throughout your labor? Or do you want to lead the way? I know this can be a challenging question, but imagining yourself in labor can help you decide what type of woman you are and what you’re looking for in labor.

A good doula is able to mold herself into what you need, so if you change your mind in the middle of things, she should be able to move along with you.

So, what to ask?

- How many times will we meet? That answer should be at least twice during the pregnancy and once or twice afterwards; most meet with you twice afterwards.

-When do I call you? The answer should be “Whenever you want to.” Doulas should be available via phone, text, email throughout the pregnancy and then physically available from 37-38 weeks along. I say 37 or 38 because doulas have different beliefs about call-time. If you suspect you will go early (and not just because you hope you go early!) you might make sure you hire a doula who will come earlier.

- What If I have pre-term labor? Will you come? Most would if at all possible, but if you’re having pre-term issues, it would be good to ask the doula this question.

- When do I call you in labor? Again, the answer should be “Whenever you want to.” (I tell women, “If you think, ‘Should I call Barb?’ the answer is ‘YES!’”) Women need to be able to touch base with their doulas in early labor even if the doula is hours away from going to them. Through repeated phone calls, the doula and client can decide when the right time to get together will be. Depending on whether the doula is meeting you at your house or at the hospital depends on how far along in labor you will see each other. If you want a doula sooner than later (you think), mention that to the doula. Make sure she goes to the mother’s home before you find out in labor she’ll only meet you in the hospital.

Now, I have no qualms about a doula meeting you at the hospital instead of in your home. It’s what I do if I doula. I am uncomfortable laboring with a mom at home when she isn’t monitored, so only do monitrice work when a woman wants me to come to her home in early/ier labor. But, many doulas don’t have any issues with going to women’s homes and that’s fine, too. Just be sure you know what your doula will do before you get there.

Some answers you might hear include: When you can’t walk or talk through a contraction; When you feel you need me or When your contractions are less than 5 minutes apart. All of these are valid answers, none better than another.

- Who is your back-up? No matter how wonderful your doula, things happen and sometimes she won’t be able to make it to your birth. She or her kids might be sick. Someone in her family died. There might be another client in labor and she’s already committed to her (because the other woman went into labor first) or because her car broke down… all of these but the car have happened to me with clients over the last 30 years. It’s rare, but can happen. I have a couple of great (female) back-up doulas that are glad to meet with clients beforehand, but don’t have a monitrice back-up (yet). I am clear with monitrice clients that this might happen and I will refund them the difference if I have to send a doula instead of my going when she’s in labor. It’s best if your doula is able to connect you with her back-ups, even at least with a phone call so you know how to reach her/them if necessary.

- How do you see your role? This answer can be endless and this is when your own expectations come into play. Typical answers would be: As someone to soothe you when you’re in labor; To help you before, during and after the birth and As an educator to help you know your options in birth. It is important for a doula to be a teacher of some sort… not necessarily a childbirth educator, but have a teaching gene. She’s going to let you know your options in birth, help you learn how to communicate your wishes to the hospital staff and will probably help you get started breastfeeding (if that’s your choice). Will she help you with your birth plan? Most will help you with that, even if they start with a standard birth plan off the Internet. If she’s a good and experienced doula, she will help mold the template into your unique birth plan. (There’s nothing worse than presenting an Internet birth plan to the labor and delivery staff.)

During the interview, take note of the type of person she is. Is she direct and clear? Will that come across as bossy to the hospital staff? Or is that a trait you appreciate in a person? Is she meek and mild? Will she have the strength to guide you in labor when you need someone strong? Is she full of ideas for your comfort measures even now or is she only focused on labor? A doula who has information for you at the point you are in your pregnancy is a great doula! She will have loads of ideas in labor, too… and she isn’t afraid of sharing them with you. It also gives you a glimpse into her experiences.

- What kind of births have you seen? Has she been to VBACs? Twins? Cesareans? Moms with preeclampsia? Inductions? Natural/Unmedicated births? Moms who’ve hemorrhaged? Births with certified nurse midwives? Home births? Birth center births? Shoulder dystocias? The more complications she’s seen, the more births she’s been to –because they are generally rare and you have to go to a lot of births to see some of the more unusual ones. What does it matter if she’s seen complications? She’s not the one managing them, right? What it can tell you is that she will have acted/reacted in an emergency, helping her client through a crisis. This can be crucial to a woman’s postpartum adjustment period, how the complication went down at the time. Especially with cesareans since those are so common; it helps if the doula has gone through this with a client so she can guide you if you’re going to have one, too. Knowing the cesarean ritual helps the woman to prepare for what’s coming and can help her assimilate what happened postpartum. If she’s been to natural births, that lets you know she can work with a woman through the whole birth experience without medication… this is a totally different experience than when she has an epidural. Helping women through pain for hours and hours takes stamina and creativity. Then, working with women with epidurals, as different as it is from natural birth, takes a different type of creativity… does she work with peanut balls? Does she know the routine side effects of epidurals? Will she be comfortable sitting on her hands while the mom and dad sleep, sometimes for hours?

As you can see, there are many more ways to tell if you’re going to have a positive/good doula than just a personality mesh, although that can’t be overlooked either. After everything, do you and the doula get along? Does she look you in the eye? Does she include your partner in the discussion? Does she have ideas for him/her to help in labor, too? Is this someone you wouldn’t mind spending 20 hours with in a small room? If she irks you in any way, I’d say PASS on her and find another one. If she annoys you in the interview, how is she going to affect you when you’re tired, hungry and in pain? Find someone who will comfort you. You deserve to have the best doula for your pregnancy, birth and postpartum. I know she’s out there!

Sunday
May122013

Responsibility

Yet another home birth was deemed senseless. Joseph Thurgood-Gates was born in the hospital after a trying attempt to deliver him at home. The mom, Kate, had had two previous cesareans and the baby was also found to be breech about two weeks post-dates. The mother ignored not only the doctors who recommended she have a repeat cesarean, but even the midwife when she recommended (most likely) an NST at the hospital ten days post-dates. The coroner, Kim Parkinson, not only said they baby would have lived had he been taken care of in the hospital from the beginning of labor, but especially when the mother had a uterine rupture. She then commented, "To disregard the obstetrician's advice on the basis of a mantra founded in the uncertainty of statistical data obtained from the Internet is a dangerous course to follow."

When I commented, “The woman’s Internet “advisors” are just as guilty for this baby’s death,” a woman replied that no they aren’t, that we each make our own decisions.

So, who is responsible for the baby’s death? Is it the Internet for its anonymity and copious amounts of misinformation in the name of “telling the truth?” Is it the midwife who wrote in her notes that there are "’lots of political issues’ relating to home births?” Is it solely the mother’s because ultimately she made the decisions?

I bet those Internet advisors will find a way to incriminate anyone but themselves and the mother because mothers are rarely accused of doing anything wrong when it comes to home birth deaths. Even when it is their fault.

There are others culpable, though.

Entire websites are set up to convince women that medicine is evil, that doctors have nothing but dollars on their minds and that cesareans are the worst thing possible in a woman’s birth story. I could name five off the top of my head, but if I know them, then others do, too. There are a few that take the opposite stance, that home birth is evil and home birth midwives have nothing but popularity on their minds and that giving birth naturally is just for the experience. (I strive to be in the middle.) Neither is 100% correct, but desperate women cling to the fringes. Why is that? What are they looking for besides answers? Why do they look for the information they hope is true instead of balanced information? I’d need a psychology degree to answer those questions. It’s rather pitiful and sad, though, that they do… that there are women right now doing the exact same thing. And there are plenty of women out there validating their wishful thinking.

How many deaths and injuries need to occur before the Internet advisors start taking responsibility for their actions? Will they ever figure out the role they play in all of this? I would like to think so, but don’t hold out much hope for it. I don’t know how to get these women to own up to their behaviors, their advice to unsuspecting women who desperately want help over the wires.

Or how do we comfort the despairing woman? How do we help her so she doesn’t turn to the edge of sanity for information? Women can be so damaged; there has to be a way to help them before they go over the edge of sanity… the sanity of not taking medical advice from strangers.

Friday
May032013

Jason Collins Comes Out

 

I never write about sports, but this piece of information bears a short post.

Jason has become the first American to come out who plays a major team sport: NBA basketball. H’s a free agent at the moment, but has played for several NBA teams, including the Celtics. He’s gone to and won many competitions and has his share of awards.

Before Collins came out, before his trade to the Celtics and Wizards, he asked for the number 98 to honor Matthew Shepard who did a horrific death for being gay in 1998. Quite an honor and loud-spoken commentary.

Collins just came out on Monday… I just laid my hands on the Sports Illustrated story today… so it’s still early to see what lashing out there will be, if any at all. So far, things look good. Big names in all sports venues are rallying to his side, supporting his choice to come out now instead of later.

I just wanted to offer my support to Jason Collins for being himself… not necessarily brave or wondrous, but just for being himself. Thanks for coming out.

Thursday
May022013

AAP's New Home Birth Guidelines

The American Academy of Pediatrics came out with some guidelines for a safe home birth after first stating the safest place to deliver was in the hospital and in a birth center.

The guidelines, in bold italics, state; (my comments in afterwards):

- There should be no preexisting medical conditions.

This would rule out thyroid, heart, renal disease and more. Most home birth midwives wouldn’t have a problem with someone with thyroid disease, but would risk out for more serious diseases and conditions.

- There should be no diseases during pregnancy.

This would include not having women with diabetes in their practice. CPMs generally accept and keep women with diabetes as long as they aren’t on insulin. For the rest of the diseases of pregnancy, Preeclampsia, Pregnancy Induced Hypertension, HELLP Syndrome, etc., most midwives would risk out. There might be some midwives who wouldn’t recognize the lower levels of these issues and a few might not appreciate the gravity of the diseases, but most would.

- No one with twins, triplets or higher should deliver at home.  

We know this is one that is ignored too much.

- The baby needs to be vertex (no breech).

This one is also ignored too often, many/most midwives believing that breech is a variation of normal. It is not. The number one reason a midwife ends up arrested is because of a breech death. (This is my informal observation over the years.)

- The pregnancy should be at least 37 weeks, but no more than 41 weeks.

The 37-week limit is a common demarcation point although some midwives would deliver a woman under 37 weeks with specific clients, believing it’s okay to step out of the rule for special circumstances. This is one of the issues I have with CPMs; they don’t have hard lines, but find so much ambiguous. It’s part of what women want in a midwife, being seen as an individual, not a number, but there does come a time when hard lines should be drawn in the name of safety.

- The AAP says that labor needs to be spontaneous or induced as an outpatient.

Induced?! What were they thinking?

- Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board.

This means they recommend only Certified Nurse Midwives, not CPMs.

- There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.

This would include intubation, something the majority of home birth midwives do not do. However, even if one learns intubation, we don’t get a chance to practice it and it is a skill that requires constant practice in order not to injure the baby. It is a nuanced skill that nurses practice a lot and/or use more frequently than a home birth midwife would ever have the chance to do, mainly because most of the babies we see are from (or are supposed to be from) low-risk women. So the likelihood of ever being able to do this regularly is remote… something we might just have to scratch off the list of being able to do… keeping us from being 100% accepted by the AAP.

- A newborn infant who requires any resuscitation should be monitored frequently during the immediate postnatal period, and infants who receive extensive resuscitation (e.g., positive pressure ventilation for more than 30–60 seconds) should be transferred to a medical facility for close monitoring and evaluation.

30 – 60 seconds is too ambiguous and ambiguity is the hallmark of CPMs. I wish they had said 30 seconds and left it at that.

- Home birth mothers and caregivers also should take any infant with respiratory distress, continued cyanosis, or other signs of illness to a medical facility.

I’ve seen, many times, a baby with central cyanosis receive blow-by oxygen for extended periods of time. “The baby just needs to nurse!” is what so many midwives believe. Annoying. That the baby does transition eventually reinforces their actions, but what of the babies that do have problems that need to be watched by an NICU staff? What happens to them? They are delayed and delayed going in.

- All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored.

This is always done in my experience.

- A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.

Something that cannot be done for many midwives whether because of legalities or hostilities in the community.

- AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests.

While many home birth families refuse Vitamin K and Erythromycin eye ointment, midwives who can, do carry it for those that want it. When a midwife can’t do something, like the Hep B vaccine, she would send the baby to the pediatrician to have it done. Same with the bili checks; blood work is done via the pediatrician, so it isn’t ignored, just that we don’t typically do that lab test. There are home bili tests, but they aren’t as accurate as blood tests. In my experience, even with the home tests, if there is a question, the midwife would send the baby in to be checked by the pediatrician.

- The baby needs to be monitored every 30 minutes for the first two hours and consider transitional care to be 4-8 hours postpartum.

Midwives at home monitor more frequently in my experience. Not a complete newborn exam every 30 minutes but absolutely doing vitals. Most midwives stay at least 3-4 hours postpartum. Now maybe we should stay a minimum of 4 hours?

- If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening.

This would be something I would hope all midwives do, but I know too many don’t even test for GBS in the pregnancy, much less treat with antibiotics in labor. This must change. I worry how may babies have to die of GBS before home birth midwives get the connection between testing and a live baby. Then there’s the LGA babies that need to be tested for glucose levels, but midwives often merely go by symptoms and even then don’t test. I would like to see glucose monitoring of newborns become more common.

- Comprehensive documentation and follow-up with the child’s primary health care provider is essential. They want to have the baby see  a pediatrician within 24 hours after the birth and again 48 hours after that first visit.

A variation of this is done by most midwives. Some will say the baby needs to be seen within the first three days and others within the first two weeks. I err on the side of caution and liked my clients to see the Pediatrician within the first three days. AAP takes a much more conservative take and wants the babies seen much sooner and more often,

As I’ve read through the articles about the new guidelines, there have been some comments from CPMs saying they are glad for the guidelines because all CPMs do them already. As you read above, that isn’t true at all. There are specific items on the list, namely risking out for diabetes, intubation and vaccinations, that most (if not the great majority of) CPMs do not do. These need to be known and if we want to win the hearts of the AAP (and the public), we might consider adding stringent limits with diseases and intubation into our repertoire. And many midwives are wont to limit their clients to normal, vertex, singleton mothers and babies, instead being led by clients and their needs, not adhering to what is proven safe for those wanting a home birth. It’s frustrating when midwives take these high/er risk women and things go wrong. It makes all midwives look careless and ignorant of risk. If we were able to adhere to strict standards, perhaps CPMs might finally be included in the professionals’ recommendations. I don’t see that happening any time soon.

When we get standards from others such as this and we’re able to compare the requests with the realities, it is perfect for giving the CPM areas where she needs to increase her education and skills training. I’m often asked what exactly do I think midwives need to learn and this post is perfect for that. Tops is learning to adhere to the Standards of Care of not step out of the boundaries just because the midwife feels sorry for the mother. There is nothing mentioned in this piece about malpractice insurance and that should be a requirement, too. I can see, with increased education and skills training and standardized education (not the haphazard methods there are now to become a CPM) and malpractice insurance, CPMs finding a more accepted place in states. But there are still too many challenges that don’t fit the exacting standards of ACOG or AAP. I hope we midwives strive for what their looking for, not minimize their requests. It is in our self-care that we will be able to garner more and more respect. With respect, we get laws on our sides, Medicaid payments, all states with CPM laws and a great reputation. It’s time we had a great reputation.

Sunday
Apr282013

Nursing School Worries

I’ve had several women come to me lately telling me they are entering nursing school, but are worried about losing their natural/home birthing mindsets. While I haven’t gone to nursing school myself, I have talked many women through and wanted to share some of my thoughts about how to keep centered even while moving into the medicalized world of nursing and hospital care.

The biggest concern seems to be having to do extraneous things that have nothing to do with midwifery… orthopedics, cardiology, geriatrics, psychiatry… all seemingly so far from birth work, but in reality, have everything to do with birth –if you just look with a soft-focus lens.

Everything you do in nursing school (and nursing in general) has something to do with midwifery, even if they seem so far away.

Why would you need cardiology in birth work? Part of the job of a midwife is to determine if mom has a heart murmur or not. Heart murmurs can be indicative of underlying cardiac conditions that need to be addressed by specialists. Also, listening to newborn hearts is a crucial part of immediate postpartum care. If you’ve listened to a thousand hearts, most of which are normal, you are able to quickly determine if there is an abnormality in the heart you are listening to. As an apprentice midwife (out of hospital apprentice), you don’t get the chance to listen to the wide variety of hearts that you do in nursing school. It’s a distinct advantage to be able to hear so many hearts.

What would geriatrics have to do with midwifery? Besides listening to the heart advantages, there is also the ability to work with folks with depression, orthopedic issues (more on that in a moment), chronic pain and family dynamics… all aspects that have to do with the care of women in the childbearing year and beyond.

Orthopedics? What in the world does that have to do with birth? One of the first things a midwife does with a new baby is check his or her clavicles to see if they are broken. Knowing what a break feels like as well as how to refer out if necessary or even how to fix it can be crucial for a midwife. Plus there are other physical conditions a newborn can have that a midwife needs to be aware of: hip dysplasia, club foot or femur fractures can all be a part of what might happen in birth.

Time in psychiatry is infinitely helpful because midwifery is all about the psychology of things. Getting to know a family, deciphering whether there is abuse in the family or not, understanding eating disorders and more are all covered in the psych portion of nursing school, something that isn’t typically covered in non-nurse midwifery education. It’s something we pick up along the way. I learned a lot from my own years in therapy.

So, putting the positive spin on nursing school can help keep your eye on the prize of the nursing degree.

What of possibly losing the idealism of out-of-hospital or natural birth? Won’t nursing school ruin the belief that birth is normal?

I always find that question so interesting. If you have the belief and there is nothing to counter it, you’ll stick with the belief. If, however, you have information that shows otherwise and you change your viewpoint, then that is the perception you’re supposed to have. If there is nothing to change your point of view, then you will stick with it. But, nursing school does change perceptions because there is new information, why wouldn’t it? Does it make you not believe in natural birth anymore? Not in my experience. It widens your attitude towards birth, eventually bringing the two (or more) positions into alignment. Is there a way to be a nurse and still believe in home birth? Absolutely! There are plenty of nurses who have their babies at home. They are probably more discerning about whom they choose to oversee their births, but they do believe in their abilities to be safe while birthing at home.

You know you’re going to learn new information. Why wouldn’t you want it to blend with your already strong knowledge of birth? Do you really feel you will be brainwashed? Or might your beliefs be questioned. Now, that isn’t such a bad thing. We should be able to stand strong in our beliefs even as someone stands in front of us showing us counter-proof. If we shift, we are brilliant humans, using all the information at hand and developing a new mindset. There is nothing wrong with that.

Will you see things that make you crazy? Absolutely. Will you want to reach out and stop people from doing things that you know to be dangerous or bad? You bet. Will you do it? Or will you stand there and learn. You will learn. Even when someone does something that you think to be dangerous, you must sit still and learn because there really might be another way to do what you’re watching. And even if you say to yourself, “I will NEVER do that to a woman,” put the skill in the file drawer because you never know when you might need to do just the thing you’re finding abhorrent. I remember learning how to do controlled cord traction. My mind screamed at me to stop; it was a horrible thing to do with a placenta. But, I sucked it up and learned. Was I ever glad when I had to get a placenta out from a hemorrhaging mom. I never thought I’d use the skill, but thankfully, I paid attention and learned anyway. I’ve learned there can be a reason to use any skill you acquire along the way, no matter how awful it seems at the time.

And that’s the way it is with nursing school. Even with all the things you think you’ll never need to practice home birth midwifery, you are wrong; you will utilize every extra skill and piece of education that comes out of nursing school. Midwifery school, even more so. But that’s a different post.

I hope this helps those wondering about nursing school and having concerns or second thoughts. I hope you’ve found some peace about the possibilities that await you in a place completely foreign from anything you’ve ever known. What an adventure! I only wish I had gone that route when I was your age. But now I get to share my old lady wisdom with you all who might go on to be awesome nurses and possibly certified nurse midwives. I am all the way behind you. Go for it!

Friday
Apr262013

Women Get High From Epidurals?

Really? This is what, in part, an article by Judy Slome Cohain, originally published in the Autumn 2010 Midwifery Today, says. From what I understand, Cohain is a Certified Nurse Midwife, making her comments/beliefs even more confounding.

“They get a little buzz and feel a bit tingly high from the relief of pain and the fentanyl and smile from the high. It seems a shame that they are unaware that they could get that high by learning how to find the place inside themselves that releases it naturally, or by surrounding themselves with other high people. Also, if the woman feels the fentanyl high, then the baby must be getting it also….”

Her interpretation of what women are feeling is bizarre. It isn’t that they are high, they are relieved! Is the baby relieved? Probably from the stress hormones’ minimization.

The really long article waxes poetic about unmedicated birth, saying,

“The biggest lesson I’ve learned from 25 years of assisting births is that there are no two people on earth alike. Each woman is a completely unique entity with different tastes, needs and desires. By enabling a woman to birth at home—or in any place she chooses—where she can find the position, place, smells, atmosphere and surroundings she needs to birth, she can birth practically without pain. I am not only referring to people who meditate and do hours of yoga every day. I’m talking about Mrs. Couch Potato, too. I could describe hundreds of women who did not feel much pain during birth.”

I haven’t been a midwife for 25 years, but I can surely tell you that there were plenty of women who felt a great deal of pain in their home births. Some so much, they transferred to the hospital for pain relief; not many, but a few. Pain is one major reason first time moms transfer to the hospital.

Cohain also says,

“The task of labor is to breathe and relax for 30 seconds of contraction. This can easily be accomplished by the most unimaginative person by walking slowly and counting 10 slow breathes. An imaginative person can connect to the place in her body where she can release her natural endorphins and get a natural high. She can surround herself with a few people who love her and get a contact group love surge. She can connect to her power or whatever power she wants to let flow through her—it’s much like the energy you get watching a great concert, or a shooting star, or a child take his first step. As this energy flows through her she can imagine herself powerful and giving life force to others, praying for the health of sick people she may know. She can kneel down in soft, green grass and suck in nature’s bounties. It can be tiring, but the longest it will last at significant strength is 12 hours.”

30-second long contractions are in early labor and that is typically the least uncomfortable time, but for some, it is still painful if the baby isn’t in a great position. And the longest hard labor lasts is twelve hours? She must have some speedy women giving birth around her.

I’ve been to births that sound like what Cohain describes above, but they were the unusual, not the typical. I’ve also been to hospital births that were just as ethereal as these home births she describes. Has she not?

“Watching a woman get an epidural reminds me of watching a teenager have a bad drug trip. Birth is not a terribly painful process in the comfort of home, although going to the hospital doubles it.”

It makes me very uncomfortable to read such statements. Sure, staying in the bed without movement can be more painful, but more and more hospitals are “allowing” women to move around in labor, even as they are tethered to monitors and an IV. Saying that birth isn’t a “terribly painful process” at home discounts all those women for whom birth is terribly painful.

Cohain even attacks the verbiage used around epidurals, although, as far as I know, she gets even that wrong. She says,

“Although the euphemism, ‘She took an epidural’ is universally used, no woman can take an epidural. She has to be given it.”

In my 30 years of experience with epidurals, the woman got an epidural, she didn’t take one. Have you all heard of taking one?

There is great detail about a woman in a hospital bed and getting an epidural, including the erroneous information that says,

“The anesthesiologist takes a large gauge needle on a 5 or 10 cc syringe and starts digging into the laboring woman’s back. The hole has to be large enough to fit the drug-bringing canula which goes in 4 inches, or 10 cm, in and up her spine. Blood flows down her back in a half-centimeter stream from the hole. It hurts to be stuck.”

First, the woman gets a shot of lidocaine so she doesn’t feel the needle going into her spine. The doctor also doesn’t “dig” into the woman’s back; he knows precisely where he’s going. While it does sting like a bee sting for the lidocaine poke, the insertion of the needle and then canula are typically felt as a lot of pressure, not pain.

At one point, she says that Bupivacaine is an opioid, which it is not.

And her belief that women get high from epidurals is laughable if she weren’t so serious. Accusing women of wanting to get high in birth is downright rude; women are wanting to have pain-free births and have that option in a free world.

It’s sad to me that Cohain doesn’t seem to have seen some beautiful hospital births, that the only lovely births she’s seen have been home births. I’ve seen some hospital births that were more wonderful than some home births.

I’m tempted to write a birth story where a woman starts out at home then transfers to the hospital for an epidural, words billowing melodiously. It could happen.

Sunday
Apr072013

Judging Birth Stories

I asked this on my Navelgazing Midwife Facebook Page "When you tell your birth story, do you feel judged?" and while I knew the answer, it was still enlightening to hear what women had to say.

TJ: I sometimes feel judged as a midwife because my birth experiences weren't 'midwifery enough', but fortunately many women I care for don't ask.

MS: I don’t tell my story because nobody cares to listen to other peoples stories.

NgM: I don’t find that true at all. People love hearing others’ birth stories.

HS: Always. And crazily enough, it depends on who I'm telling it to what ~type~ of judgment I feel.

EB: It hasn't occurred to me to care.

AF: I love to share my stories.

The first one is a thriller full of tension and drama, and honestly, Hallmark movies don't get nearly the ratings of The Walking Dead.

The second one is pretty boring with the exception of the kid peeing on the OB as he was held up for me to see. That's about the only part I share often. Humor sells too.

Do I tell them often? Nope. I don't get asked much now, and I didn't get asked much when they were young either. The average person is not interested.

The people who think birth is supposed to be this amazing transformational experience don't think much of my stories because they aren't about magic moments and soft focus pictures. I'm not interested in rewriting my experience to fit their favorite narrative.

CF: You know what's funny? I actually had a pain-free, intervention-free birth (thanks Hypnobabies) and was too embarrassed to share my story for awhile. The moms I knew seemed to enjoy sharing their stories, which they were overwhelmingly not happy with, but they didn't seem receptive to hear about enjoying my pregnancy and having fun while giving birth. I almost ended up feeling like I was apologizing for having the kind of birth I did. It took my best friend helping me to understand that women wouldn't know this kind of birth was even possible unless it women shared those experiences. I was so scared of women feeling like I was saying their experience was less than mine if I shared, but that wasn't ever what I was trying to get across. So I've found myself carefully framing my story to make sure they still feel validated and heard and that they know I truly believe that each story is unique and worth celebrating.

SBN: Yep. With both - the epidural-first-time-mom-not-quite-my-own-advocate and my non-meds one that was serene and minimal. You can't win.

HS: Seeing an interesting trend on this thread.....It appears a lot of moms who've had positive experiences (whether natural, augmented, or surgical) feel reluctant to share their stories. So many women love to share their horror stories of birth, either their own or someone else's, that hearing a happy one is almost taken in offense.

CK: It's a rock and a hard place when you want to vbac. Especially when you want to vbac with no epidural. Have you ever been on magnesium sulfate? That is some nasty stuff, and a huge game changer when your plan for pain management includes lots of movement and a tub.

EC: No, however I don't share much in mixed company because so many people have negative stories. Mine are both mainly positive and I think that can annoy people. Same thing when I share about my breastfeeding success. So I guess it is a kind of judgment, or maybe they are afraid that they are being judged by me (they're not!)?

HMD: Certainly. People think, "how boring..."

LSA: It depends on who it is I'm telling it to.

SSC: My first pregnancy was really enjoyable but the birth was awful and my second pregnancy was not as enjoyable but the birth was wonderful. I find that you just can't win. I frame telling stories about both based on the audience.

HMD: Mine was neither happy and exciting, nor terrifying and dangerous. But it was anti-climatical to the pregnancy. I should write that up, with pictures.

AF: You should go with the narrative: "My pregnancy nearly killed us, the c-section saved our lives.".

I think that's fairly accurate.

CK: Yes. My first had heart issues, so he was born via c-section. My second was a vbac attempt +preeclampsia +OP +failed induction. I feel like I’m being judged when I talk about it, but I know a lot of it comes from my own negative feelings about both births.

DH: I always feel bad for mothers with pre-e that really puts them between a rock and a hard place.

AF: Pre-e puts you into a high risk pregnancy which can usually be managed effectively by an experienced HCP. I don't see the "rock and hard place" unless a woman has a problem with managing a serious condition properly.

AS: No. The only people I tell my story to are friends, family, and coworkers, and none of them are judgmental

MF: Yes - but it never matters - for it hurts more not to tell people about Finley (her baby that died). And with Toni-joi's I am the one that judges the choices I made.

APH: No, but it's not something that comes up these days. My baby is 17!

SM: Often. I don't care much. I still share.

DRS: I had a c-section because of breech position with my daughter, and felt judged before I (had the) birth, with all the advice on how to flip her, being 4'10", it was unlikely. With my son I fought hard for a VBAC and had a hospital delivery, went into labor naturally, but had an epidural, he aspirated meconium so was in the NICU for 5 days. After that experience I could care less about judgment since I fought hard to do my bet for him and he is now EBF and healthy!

EEC: Well, I had C-Sections, so yes.

SWM: It depends who I tell it to....

MM: Every time.

EG: No, but I try to frame the stories for the audiences. I've had an induction-epidural hospital birth, a narcotic hospital birth and then two homebirths. I can relate to almost everyone!

JB: I no longer tell my story, bits and pieces yes, but not the whole thing. I no longer share it because my trauma has grown into love for myself and my journey. Am I still pissed about parts of it? Sometimes. When I did share my story a lot I felt my own self judgment the most. When I hear other birth stories, as I have learned to love my own, I have learned to love and accept their stories. Before I processed my journey, I judged others as harshly as I judged myself.

GS: Yes.

LSL: After my first Hypnobabies birth I wanted to tell everyone how awesome and comfortable it was. I was laughed at and made fun of by main stream mom friends and got the attitude from my natural birthing friends that I wasn't one of them since it wasn't a painful experience. I had another pain-free hands-off  Hypnobabies birth a few years later and I still don't share that story unless I know someone well.

SB: Yes and no. Those people who hate homebirth or are anti-midwife judge me for having di/di full term twins at home. Everyone else thinks it is great, including me and my family.

NgM: Here I am talking about not judging and my first thought about your birth, SB, is “No way!” I don’t hate home births nor am I anti-midwife, yet I still question your smarts in birthing di/di twins at home. I wonder if you’ll change that viewpoint over the years as I did my UC birth. How much judgment was in that comment? Bad, Barb… but being honest.

TR: Yes all the time. I had an emergency c-section and our baby had to be resuscitated. Since then I've had 4 more sections. I just don't offer that info anymore.

KS: I've come to peace with my first birth that led to a c section, the other 2 I feel went exactly as they were meant to, and the interventions that happened were needed - I managed the timing of them and never felt out of control. I don't feel judged at all when telling my stories.

AB: A lot of people think that I'm insane for homebirthing.

LA: Knee jerk: uh, no. Thoughtful answer: it depends on who I am talking to. I never feel judged about my hospital birth, my unassisted home births (some planned, some not) tend to leave jaw drops from most, and inspire horror from most medical professionals.

KDK: No. But I generally don't share in a judgmental atmosphere and I'm confident and unapologetic about all my births from my C-section to my storybook VBAC. Usually I get FAR more judgment surrounding the number of births I've had vs. the kind of births I've had.

RAJ: Yep.

AN: I find that the only people who really ask are the types that want to judge. I had an uneventful unmedicated hospital birth so it usually passes without judgment from either the NCB camp or the mainstream camp.

EWC: Yes frequently, especially my first.

SC: I only tell if people ask. The only people who ask are the ones who either really love me or really love births, or both, so no, no judgment. I do sometimes mention to others (especially mamas expecting their first) that I had a really easy, short labor and delivery... I leave it at that unless they ask, but I think it's nice to hear positive, non-scary stories, since people mostly hear the bad stuff.

MH: I don't share my birth stories mostly. Very few know them.

KS: Yup.

MM: Not in real life, but on the Internet in most birth related groups I often feel like I need to add a disclaimer about why my inductions were 'necessary'. The judgment doesn't bother me (it's people on the Internet for goodness sake) but I do hate that I find myself trying to justify irrelevant aspects of the events that gave me my three beautiful sons.

HH: There is nothing better to start the conversation with "I've had 5 sections." to be judged.

DH: At times, yes, (depending on who I tell it to) - like I was stupid for taking such risks (VBAC and attempted VBAC that ended rather dramatically - but safely - in a cesarean). One person, a dad, actually, asked me, "So, you had an emergency c-section?" I told him, "That depends on who you ask." I'm not sure he knew what to think.

LW: Yes, in the best way possible! Judged as a WINNER!

AMJ: Yep. Homebirthers seem to think I shouldn't have transferred (for prolonged first stage/swelling cervix/length of time since waters breaking), and non-homebirthers seem to think I should have just been in hospital all along….

TP: I think you showed courage and common sense.

MC: I'm judged more as an activist because I was a failed induction c/s... like the attitude is "who are you to be on a soap box when you did this"

ST: Yep.

BR: Always.

KW: Nope and I'm especially proud of my unassisted birth.

MB: I couldn't care less if someone else wants to judge me!

ALB: Yep.

NgM: I remember the first time I felt judged. It was by my future Bradley class (a group of us were in an exercise class together) and I had just told my hospital birth story, showing the pics and everything. It wasn’t right away, but when I realized these were natural birthing women, I asked how they could stay quiet about my birth and they said they knew I would eventually figure out the error of my ways if I hung out long enough. I was so embarrassed. I’m angry that I felt that way now; one should never be ashamed of one’s birth story.

I was totally judged for my Unassisted Birth (no more than by myself nowadays), thought I was crazy for doing what I did. (I concur.) The third birth (a car birth) was always told with such humor, no one could possibly judge any part of it, even though I wasn’t home birthing (membranes ruptured seven days before labor started… oh, is there judgment there!?). I also didn’t care what anyone thought, so wouldn’t have noticed judgment if there was any.

What can we do about judgments with birth stories? Is there a way to change the culture from one of “How could you do that?” to one of “How great that you did that!” – no matter what kind of birth it was.

Notice how many women said they judged themselves. What kind of culture exists that causes a woman to second-guess her birth? Why can’t the birth stand alone, without a comparison or contrast? Is there a way each of us can phrase comments that don’t make it sound like we are judging? Can we just state: “from here on out, there will be no judging and the assumption is there is no judging” so we can just go on, women feeling safe to tell their stories? That’s what I’d like to see.

And then there’s the compulsion to judge women’s births. We need to nip that urge, too, before it smears its ugly self all over a woman’s story. How do we re-program ourselves to not think, “She shouldn’t have x, y, z, but should have a, b, c instead.” Is it human nature to judge? I’d love to ask a sociologist! But, even if it is inborn, there are ways to de-program those thoughts so we don’t hurt those we’re talking and listening to.

Can we just listen with an open heart? Hearing the woman’s story for what it is? This is what I propose. That we suspend our thoughts and judgments so we are able to listen, really hear, what the person is saying as she tells her story. So many of us know what it feels like to be judged, imagine what it would be like if we all took the time to be in the moment with the story, not second-guessing or re-creating it with our own prejudices. Wouldn’t that be awesome? I say we all start doing this now and encourage those around you to do the same. Judgments suck, all the way around. So let’s eliminate them and allow women and their births to just Be. As they are. Beautiful and powerful and awe-inspiring, no matter how they unfolded. Or difficult and painful and achingly sad… if that is how the birth went. Allow the experience to be what it is, no matter what. What kind of world might we create if we were all able to let go of our judgmental selves? I believe a rather nice one.

Saturday
Apr062013

Eliott's Birth Story

This is my part of Eliott's story:

Eliott was born at 9:27pm on March 18, 2013, the midwife Lauren doing the delivery. As he was born, his cord was clamped, then cut, and Lauren placed him in the blanket I was holding. I started to put him in the isolette… a habit… but then immediately said, “I’m going to hold him” and walked to the rocker and proceeded to hold him for the next hour, rocking him the whole time. 

When I got him, he was so warm from Meghann’s body and I held him close until the only warmth left to feel was my own. Then I held him closer, wanting to keep him warm. I looked at him, described his body to Meghann and Brian and they chose not to see him at the time. Meghann ended up not holding or looking at him, but Brian did see his body, from the neck down. No one but me saw the head, which, to me, looked like a bunny. Meghann said she wanted to think of him as a bunny, not as a deformed baby. I understood. Brian held his son after I’d been holding him a little over an hour. 

Before he did, I went and got a warm washcloth to clean Eliott of the little bit of blood there was on him. It felt ritualistic to me, bathing the dead. I gently washed his little arms, his back and then his long, thin legs. I wrapped him in the ultra-soft blue and brown blanket Meghann brought for him. He was ready for Brian to hold him. Brian sat on the end of Meghann’s bed, crying softly over his son. It was a tender and precious few moments. 

Then the Pastor and his wife came in… family friends… and then Brian’s mom and sister arrived and then Linda, Meghann’s “cousin” came in. As soon as everyone was assembled, the Pastor said some beautiful words about Eliott’s birth and death and how he would forever have an impact on us. After that, Linda continued with a lovely prayer, referencing Meghann’s grandmother who’d passed and whose name (Jacoba) was reflected in Eliott’s middle name of Jacob. Most of us cried through the lovely sentiments. 

After the prayer, the Pastor and his wife left, the rest of us spending time together, my holding Eliott again until I passed him off to Brian’s mom, so she could hold her grandson, too. 

It was a long time before Brian was ready to see his baby and when he did, I set Eliott up so you could see his body, but not anything from the neck up. His body was perfect; it was his head that wasn’t normal. Brian, Jenny (his sister) and Linda came in and I introduced them to the sweet baby. After a moment, I excused myself, as did Linda, so Brian and Jenny could have some time alone with the baby. Jenny came out, too, giving Brian some time with his son. 

After they were finished, I did the newborn procedures with Grace, the RN, in a room off the patient room. We weighed Eliott and he weighed 1.7 ounces and was 5 ¼ inches long. Very tiny. We did foot and handprints on a Memento Birth/Death Certificate and then Grace did a Plaster of Paris of his hands and feet. The whole time, I talked to him and let him know how loved he was and I moved him when he needed to be moved and did the footprints myself. I also got a thumbprint of Meghann and Brian on the paper. Their thumbprints were much bigger than Eliott’s feet. 

Grace gave Meghann and Brian many gifts from an organization that gives clothes and toys to grieving parents. Meghann decided on one knitted sock to put Eliott in before he left them and wrap him in a white blanket. Up until that point, I’d wrapped him in the beautiful brown and blue blanket Meghann had for him… soft as could be. Meghann and Brian also had a bracelet that had Eliott’s name as well as a little stuffed penguin that I kept wrapped in the blanket while we all held him. I had put the blanket he was born into away so we could take it. I also took the cord clamp he had on for awhile. Meghann’s keeping the bracelet, penguin and blanket as well. 

I left about 4 hours after the birth, leaving Meghann and Brian alone for the first time since we got there that morning. They were ready to be alone with Eliott and I was ready to go lay down.

It was a beautiful birth. I loved holding my grandson, looking at his bunny face and perfect body. It was such a privilege to be with him as long as I was able. 

I’m at peace today. Feeling better than in the last week. I will miss sweet Eliott, but am glad to have the experience behind us. It was something no mother should ever have to go through.