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Wednesday
Nov142012

Amniotic Fluid Embolism Story

A few weeks ago, my daughter told me a work colleague of hers almost died at her birth and, in Meghann’s words, “if she’d have been at home, she would have died.” My family doesn’t say things like that lightly so I knew what had happened must have been catastrophic. Later, she told me the friend had had an Amniotic Fluid Embolism with Disseminated Intravascular Coagulation (AFE/DIC). The woman was still in ICU, so I let Meghann know the recovery rate was very low and to send good thoughts to her family who must be extremely distressed. The new baby was not in the NICU, so that was a good sign; the AFE/DIC happened after the baby was born, it seemed.

I kept asking after the woman’s health and she was recovering more and more. After time in a step-down unit, she went home and then the next I heard, Meghann was advocating a Blood Drive to replace the blood she’d used during her DIC experience and recovery. I asked how many pints of blood she’d needed and was told 36. Thirty-six pints of blood. That’s completely replacing the blood in the body almost five times.

In the Facebook thread on the Blood Drive, the woman herself, Michelle Moon, responded to me and I felt comfortable reaching out and asking if I could ask her some questions. I told her that I had a special place for AFE/DIC since it was the only maternal death I’d ever witnessed. She was gracious saying she wanted to help bring awareness to AFE/DIC and would be glad to share her story with me and my blog readers.

Amniotic Fluid Embolism is a rare obstetric event, occurring in 1 in 8,000-30,000 pregnancies. (Determining the exact amount is extremely difficult.) Maternal mortality reaches about 80%, but here in the United States, it is 61%. 50% of the women who die, die in the first hour. “Most women who survive have permanent neurologic impairment.” And 79% of the babies live here in the US, so the babies do fair better than their moms.

Disseminated Intravascular Coagulation is not just an obstetric event, but can occur with acute trauma anywhere in the body. A good explanation is:

“Normally when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active. This often occurs due to inflammation, infection, or cancer.

Small blood clots form in the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs such as the liver, brain, or kidney. These organs will then be damaged and may stop functioning.

Over time, the clotting proteins are consumed or ‘used up.’ When this happens, the person is then at risk for serious bleeding, even from a minor injury or without injury. This process may also break up healthy red blood cells.”

So when the person is in DIC, the body can no longer clot and the blood just flows. Unless it is replaced, not just with blood, but with other blood products (as you will see), the person will die.

In a homebirth, AFE/DIC is one of the risks women take, that there is zero chance of living if it occurs. If it happens before the birth, the baby will also die; it is a given. Homebirth midwives discuss this in in our apprenticeships and in school; it’s one of our worst fears. But, that so few women survive, even in the hospital, was always a comfort. And that those that survived were mentally incapacitated made the impending death even more… acceptable? Not that death is ever acceptable, but that if a woman was doomed to live as a vegetable (a horrid term), perhaps it was best she not live at all. It was what we said to ourselves.

But then along comes Michelle Moon; a mom who has not only lived through her AFE/DIC, but is not remotely mentally affected. (I will share her lingering affects below.)

Michelle was gracious enough to answer my questions and her answers in email were so straightforward, yet so impactful, I decided to share her story in that format. Here, in Michelle’s own words, is her story of her AFE/DIC.

“I am happy to share and help bring awareness to AFE/DIC.  It is one of those things that I never knew could happen.  You always hope and pray for a ‘normal’ pregnancy and birth.  This was my second pregnancy.  We have a healthy 4 year old girl (Bella) who was delivered in a hospital in a vaginal birth with no complications.

“My recent pregnancy was as normal and standard as the first.  I was healthy, ate right, and went to my scheduled appointments.  I went into labor on my own at home on Friday, September 28.  When the contractions were about 2-3 minutes apart we headed to the hospital.  After checking in I received an epidural, my water was broken by the doctor (NgM: a couple of hours before the AFE) and everything seemed to be progressing fine.  I was dilated to 7 cm.  Then all of the sudden I knew something was wrong.  My husband and mom were with me.  I remember jolting up in bed.  I started yelling ‘something is wrong, something is wrong, someone call the nurse.’  I still remember the horrible feeling of darkness that seemed to be creeping up my body. I remember I couldn't breathe.  There was this horrible dryness and warm sensation in my chest as I struggled to gasp for air.  I don't remember anything from this point until the following Monday-Tuesday when I woke up in ICU. 

There are a few parts that have come back to me from time to time.  But for the most part I was out of it.  My husband hit the nurse button right when I told him to.  Within 8 minutes from that point they performed a c-section.  Piper (our daughter) was not breathing when they pulled her out of my body.  They resuscitated her quickly and she is doing well.  We don't think she will suffer from any complications.  After the C-Section (Friday) I went into DIC.  Then Saturday, they opened me up again and did a second surgery to remove the extra blood and clots, then the final third surgery (Sunday) was a Hysterectomy which helped stop the bleeding.  I still have my ovaries, so no hormone therapy right now.

“I want to be sure to answer all of your questions.  Let me know if you need further information. I have pasted your questions and then my answers for each are below:”

Did you have any risk factors?
“Not to my knowledge.  My pregnancy seemed to progress just fine and I was healthy.  No complications.”

(NgM: Risk factors: “Several factors have been associated with amniotic fluid embolism syndrome. They include precipitous or tumultuous labor, advanced maternal age, cesarean and instrumental delivery, placenta previa and abruption, grand multiparity [≥5 live births or stillbirths], cervical lacerations, fetal distress, eclampsia, and medical induction of labor.” Amniotomy would not have been a risk factor.)

Induction?
“I was not induced.  Although, I was induced with our first daughter.”

Augmentation?
“”I was 41 weeks pregnant.  I went into labor on my own and was dilated to 7cm when everything happened.”

How did the AFE present?
See above paragraph”

Do you remember any of it?
“See above paragraph.  For one of the surgeries the doctors were afraid to sedate me with anesthesia because my heart rate was too low already.  They gave me some light sedative but did not completely knock me out.  This is one of the memories from the weekend that I have. I woke up during the surgery and saw the doctors and nurses above me.  I started to shake my head ‘no’ back and forth to alert them that I was awake. Someone held my head and stroked my hair to calm me down.  The other memory from the weekend is when I woke up to find the family Deacon standing over me giving me my last rights.  We are Catholic.  Talk about terrifying.  I remember thinking to myself (since I couldn't talk, not enough energy) ‘Oh,hell no... I'm not going to die.’”

What's the last thing you remember and the next thing you remember... what's the time spread between then?
“See above paragraph - Friday to Monday I was not really coherent.  I woke up in ICU with a tube in my throat to assist me with breathing.  I was pretty drugged up in the ICU so I slept a lot.  I remember having to write messages to communicate and asking if I was going to die.  I was terrified.  I was so swollen after all of the surgeries.  I had gained 40 pounds of water weight.  My eyes were so swollen I could barely see through them when I first woke up.”

Did you think they were lying when they told you how many pints of blood they put in you?

“It really is unbelievable to think about it.  I never in a million years would have thought that I would need that much blood products.  I received 36 units of red blood cells, 22 units of platelets, 12 units of fresh frozen plasma, and 8 units cryo.”

What effects have been lingering?
“My body was pretty weak after everything happened.  I was in ICU for 7 days and in Post-Partum Recovery for 6.  I am now 5 weeks removed and not in much pain. I stopped taking the pain meds last Friday.  It was 5 days after the last surgery before they allowed me to work with PT and I sat up in the bed for the first time.  It was day 9 before they let me stand up and try to walk a few steps.  My muscles are completely gone in my legs.  I walked with the assistance of a walker for a few weeks.  Now, at 5 weeks I can walk unassisted; however, my feet and calves bother me. My feet cramp and my calves feel heavy and tighten up.  I am Anemic and take iron supplements 3 times a day.”

Are they from anemia?
“Yes, very tired. I was resting a lot at first.  Now I am able to get around the house pretty well and just get exhausted at night.”

Or from other organ failure issues?
“Yes, the hardest hit organ were my kidneys.  At one point my kidneys only had 10% function.  I received dialysis when I was in ICU.  They were able to remove 2.5 liters of fluid.  My Creatinine was 6.9 at the highest and slowly has been lowering.  At week 3 my creatinine was 1.32 and they gave my kidneys an estimated function of 47-50%.  We will re-draw blood in two months to see where my kidney function plateaus.  My Nephrologist is hopeful that the kidneys could fully recover given my health and age (31).”

Are there lifelong residual issues you will have to watch for?
“At this point they say I will just need to be careful and monitor my Kidneys.  Even if they do make a somewhat full recovery, one dose of over the counter Aleve, Advil, etc. could poison them and send me back into renal failure.”

Are you nursing?
“Unfortunatley no.  I had planned to and did successfully with our first daughter.  They started to pump my breasts the first few days in ICU but it was becoming stressful for me.  So we decided since I was still not out of the woods to allow my body to heal and recover without the added stress or task of the breast feeding.  I was so full of meds that they had to dump everything they pumped.  We didn't know when the milk would finally be safe enough to give to Piper.”

Is there anything about your recovery that you want others to know about that you don't get to share too often because no one asks about it? Like sex has been impossible because of headaches or you can't lift anything more than the baby still (just random thoughts).
“The doctor's used the same incision for all three surgeries.  A few days after being released from the hospital the incision opened up.  I received a KCI Wound V.A.C. to help the wound heal.  It's been on for 2.5 weeks.  They say it should close within the next two weeks.  I can't even imagine having sex right now.  I'm still in recovery.  I'm also nervous about it.  So we will just wait on that one.  I am not supposed to lift anything heavier than Piper for another week or two.  I'm pretty weak still.  It wasn't until this past weekend that I could dress myself from the waist down or put my socks and shoes on.  I am scheduling an appointment with an Internist to look into my feet and calf cramps.  I really don't get too many headaches.  I did at first, especially when I was in ICU.  But maybe just once a week.  I attribute them more to eye strain.  They happen when I watch too much tv.  I have had a twitch in my right eyelid since this all happened.  I noticed it goes away when I wear my glasses.  The doctors think the eye muscles might have suffered some neuropathy. I remember I had a few strained blood vessels in my eyes when I was in ICU.”

I happened to travel to San Antonio this last week and was able to meet Michelle and her daughters in person Monday. It was such a privilege to take a few minutes out of her day to take a picture of her and the baby.

She certainly didn’t look like a woman who was so near death a few weeks ago. Talking with her, I learned she had help at home for several hours in the morning and then in the afternoon as well for several weeks. She’s weaned off the help gradually and this week is her first week without help at all during the day; her husband is there at night. She has a meticulously beautiful home and it was clear her four-year old daughter has been an enormous help to her through this.

AFE/DIC still is a risk in any birth and while there are risk factors, they are more risk guesses than anything. It’s true. If Michelle had had a home birth, neither she nor the baby would be here today. It is a risk one takes in choosing a home birth. A miniscule, but real risk. Those  who choose home birth weigh the risks and benefits of other more common experiences such as  lowering their chances of having a cesarean, being permitted a VBAC or having a provider who respects their wishes in birth. To them, the benefits outweigh the risks of possible death from something as obscure as AFE/DIC.

Even so, I felt it was crucial to bring a face and a name to a catastrophic obstetric condition midwives and obstetricians alike dread. I can’t thank Michelle enough for allowing me to tell her story, in her own words, which were more powerful than anything I could have written. Her story finally erases the horror of the birth/death I saw back in 1987.

Thank the Universe for modern medicine.

Monday
Nov052012

Going for a Non-Stress Test/Bio-Physical Profile:

How to Level the Playing Field

When going for an NST/BPP, a little preparation can help you make sure you are hydrated and the baby will be as active as possible before being hooked up to the monitors. This is not to fool the doctor, but to set yourself up for success. If, after following this regimen, the baby or amniotic fluid still shows there is something amiss, you will know you did your part to make sure both were as normal as possible. 

  1. Two hours before your appointment, soak in a tub full of water. Soak for 45 minutes to an hour and while you soak, drink as much of a half a gallon of water as you can. You will definitely have to go to the bathroom more afterwards, but hydrating through soaking and drinking water are two great ways to make sure the amniotic fluid index is as normal as possible. Many women are induced because of low fluid levels when they are really dehydrated. We don’t want that to happen to you.
  2. After your bath, eat a full meal with plenty of carbs. Protein is always important, of course, but you are doing your best to put some glucose into your system so the baby will be as reactive as possible. Reactivity is one of the major aspects of the NST/BPP.
  3. Before you walk into the doctor’s office, drink a full-sugar soda, a small bottle of juice or a cup of coffee – whichever you have abstained from during the pregnancy but wished you could drink. This is sure to perk a baby up!
  4. As you’re getting hooked up to the monitors, talk to the baby and let him or her know what will be happening and that you want to see a perky baby. Also tell the baby if there are problems you can’t see or feel, to “tell” you and you’ll listen and honor the message; babies are very receptive to your wishes and thoughts. 

Hopefully, these strategies can help your upcoming NST/BPP be successful. Of course, if you have any concerns, don’t hesitate to talk to your care provider.

Monday
Nov052012

The Irrelevance of Time:

a loving plea for late pregnancy and middle of the night nursing worries

Imagine you are a woman living in the jungle. You have no clocks; only seasons. You know the stars and the tides, but they are a part of your being more than a conscious thought.

Your baby grows within without conscious thought. The baby has zero concept of time. Is it time to grow a toenail? Time for that 30th hair on her head? Without any schedule or concept of time, it just happens.

Our jungle (or desert or forest or Amish) woman lives her life. She pays passing notice to the increased weight on her joints, the frequency to urinate; she lives her life. She harvests the food, or makes the bowls, or cleans the hut, or builds the house, or skins the animals or cleans the clothes in the river with her other sisters, pregnant and not. She does not have the luxury of sitting still and wondering about her body.

Contractions touch her, but things need to be done. She knows from experience that when her labor is enough to slow her down, it will be time to seclude herself. No one in the tribe even has a word for "Braxton-Hicks Contractions" or "prodromal labor" because the women have too much to do to stop and think about twinges (strong or not). The elders steal quick glances as she leans over again and again as she hangs the clothes to dry, yet no one mentions anything; the woman has enough... enough inside herself to do this work. And they all believe.

Once labor begins, depending on the culture, she might labor alone or with another woman or several women in attendance. Labor knows no time. There is no watch. No clock ticking on the wall. No one says, "You've been four centimeters for two hours now, time for pitocin." Labor is allowed to unfold in its own way. The women around her merely witness, remind her of her strength, press cold cloths to her face and hot ones to her lower back. And still, they all believe.

Pushing, the same thing... no clocks timing how long to push... that counting to ten three times for each push would seem absurd to our jungle woman! She pushes when she feels it. No one touches her cervix to feel if she is "complete." She is complete. Without anyone checking anything. Her completeness is simply a part of her existence.

The same can be said with nursing our babies. When there are no clocks, breastfeeding goes much smoother. When I was nursing my first child during the night, it would drive me wild because of how often he wanted (needed) to nurse. I would grind my teeth as I saw that he had just nursed 45 minutes earlier... that I had now been awake for longer than I had been asleep. That bred anger and resentment.

I did things differently with my second child. I learned to cover the clock - or better yet - remove it from the room. When she wanted to nurse, I was there, present, nursing my baby who, in the wilds of the world, would have clung to me for survival. It is the instinct with which she was born.

That same survival place that caused her to grow to health and wholeness inside... that didn't trigger labor until her lungs were fully ready to be born... that didn't know that I was tired when she was ready to be born (and didn't care)... that same survival place existed to remind me I was there to serve her - my body, in pregnancy and in nursing... and eventual continuous mothering. I was her complete servant. She didn't give one whit about time.

I encourage all women, especially pregnant or nursing, to let go of time. Grow your babies. Feel those tightenings. Embrace the beauty of your heartburn, your frequent peeing, your insomnia, your separated pubic bones, your weight gain... and your baby's movements under your flesh, your child's inner hiccups, your 100% safe-from-the-difficulties-of-this-world child. When exhaustion overwhelms you, feel your childs breath on your nipple, look at those silky eyelashes, touch his skin that will never be softer than this very moment, and know there will be a time when your child never nurses again. Pull this moment as tightly to your heart as you possibly can.

Time, as trite as it sounds, is so fleeting. My own heart cries for those aches and pains. My youngest is now almost three decades old and I am sorry for ever wishing any of those moments of difficulty away.

I speak here so others might take a deep and grounding breath, say a prayer or incantation if that is your way, and stay in the moment with your child. It is the only time ever you two will be alone together.
As your baby grows without guidance and conscious thought, so too, begins labor and birth. Your body producing nourishing milk continues the miracle of your perfection.

And we all believe.

Sunday
Nov042012

Let's Get Started Breastfeeding

This is the handout I give clients who are going to breastfeed.

While breastfeeding is natural, it doesn’t always feel natural learning how to do it. Here, I offer some basic information that might help you get off on the right foot. 

-          It can’t be said enough… early and often. Having your baby on your body from the beginning is the best way to learn the patterns and rhythms of your newborn. Even though most babies do not nurse for about a half hour or so, occasionally, so nurse sooner. When the baby is on location, initiating nursing is on his schedule, not the hospital’s.

-          It is routine for hospitals to wrap babies in blankets, making them look like a burrito. I encourage women to unwrap their babies, put them skin to skin and cover both of you. Research does show that when a baby is skin to skin with mother, she retains her heat better than when she is in blankets alone.

-          When you have your baby in your arms and are ready to bring him to your breast, there are two main positions to try… and I do recommend trying different positions because each one has its benefits.

Cradle Hold – Put the baby’s head into the crook of your elbow and your same hand on the baby’s bottom or holding a thigh. Babies all have a way of making this more difficult than you think it should be, so don’t be discouraged; just keep trying. At first it can be a three-person job! Pull the baby’s bottom arm around your waist and hope the top hand doesn’t go right into her mouth, blocking the nipple action you are trying to do. Some women find it easier to swaddle the baby tightly before nursing. That can keep little hands hidden, but if he isn’t swaddled tightly enough; the hands find their way out of the blanket and the whole tangle begins again. It’s really okay. You will find your own style with your baby. Having the baby’s belly against yours helps align his mouth with your nipple. We say, “Belly to Belly” – if you remember that, it can make this hold a lot easier.

Football Hold – The baby’s legs are going to wrap around your waist, her head will be in your same-sided hand. Having the head in your hand gives a different type of control over the nursing experience. Many women find this easier because they can see the baby’s mouth and can pull the baby closer than in the Cradle Hold. No matter which hold you are doing, do not lean into the baby; bring the baby to you. Now, the baby has receptors from the  chin, across the cheeks and up around the temples and they need to be left alone because, as you touch them, the baby will think there’s a nipple there and turn his head in that direction. So, when you are holding the baby’s head in this position, your thumb and pinkie finger shouldn’t go closer than the hairline. This is not an exact science, so please don’t worry if your hand is further or closer than that; you and your baby will find your own way. With your opposite hand, compress your areola slightly to make it look like a “V” and then, when the baby opens her mouth wide, pull the baby into and onto your nipple.

NOTE! When learning to nurse, it is a trial and error experience that can last several weeks. Both you and the baby are learning at the same time and neither of you need judge each other. Patience will go far, especially when he’s screaming his head off hungry. Take a few moments, take a deep breath and try again. I promise, it will happen. If you need help, do not hesitate to ask for it! Your midwife, a La Leche League leader and Lactation Consultants are your first lines of defense and can help you overcome most obstacles without bottles. I tell women: If you think about giving your baby a bottle, that is your cue to call me. 

-          For the first day or two, your breasts will probably not change very much. However, if it is painful when you nurse, please call your midwife or your breastfeeding support person. (OBs aren’t versed at all in breastfeeding and Pediatricians are not knowledgeable unless they breastfed their own children successfully.) Nursing should not hurt! It can be uncomfortable or a strange sensation, but pain is your sign that something is wrong, usually with the baby’s mouth… either positioning or a suck issue. Both can be corrected with education.

-          When your milk does begin to come in, you will watch your breasts grow several sizes from their normal shape. It’s important to know that most of the swelling is breast tissue, not milk filling them. Just as when a man has an erection, the tissue swells with blood, not semen; it is similar with the newly lactating breast. Therefore, attending to the tissue swelling is the focus for these next couple of days. Nursing continues as needed, but women can be so uncomfortable with the milk coming in that they give bottles for relief. Here, I’ll give hints for helping without bottles.

Heat before/Cold after is the main rule. Hot, wet washcloths before nursing helps to soften the breast, especially the nipple (which can get so swollen it cannot be grasped). I encourage women to keep at least four washcloths in a crock pot on low, exchanging two washcloths as they cool, back and forth, as the baby begins waking up. Hopefully before he’s screaming his head off, but even if he is, take the time you need to prepare.

After nursing, ice packs on the entire breast feel heavenly. Many women use frozen vegetables because they mold nicely on the breast. The ice helps relieve the tissue swelling, just as we ice a swollen ankle. You can put the ice packs on for 20 minutes and then off for 20 before putting them back on again. As needed between nursings, you can do as much of this routine as you like.

Cabbage leaves are a great home remedy that help the swelling diminish like magic. A chemical in the leaf relieves engorgement within a day or so. I encourage women to take the cabbage leaves off whole and put them in the freezer so when they use the leaf on their breast, it is also cold, taking care of the swelling with two methods at once. Use the cabbage leaves for 20 minutes out of every hour and only use them for two days because they can also diminish milk supply if used for too long.

Ibuprofen, by its nature, helps with swelling and pain at the same time. Many women find they need to augment with medication for pain and Ibuprofen is the best way to do that while nursing. I recommend 600 mg every 6 hours for 2 days. Ask your own care provider what he or she recommends.

Some women find homeopathics or herbs help with the swelling. Be sure to ask your holistic provider to tailor the care to you and your baby.

-          What if your nipple is so engorged the baby cannot grasp the nipple? Many women find that, while using the heat before nursing, you can express some of your milk to soften the nipple. When hand expressing, be sure to put your thumb and forefinger behind the areola and press down and then towards the nipple (which, technically, is the very tip of the areola, the darker part of the breast). It can help if you are able to lean over in a filled-with-hot-water sink, letting gravity help you with expression. You can also do this in a hot shower, letting the water spray on your breasts as you hand express to soften your nipple. Be ready to nurse, though, because very shortly after expressing, the nipple will fill again.

-          All of this can be extremely uncomfortable but really is important in helping you, ultimately, not be so engorged. The major discomfort should last no more than 2-3 days.

-          DO NOT PUMP! Pumping will only make your breasts think you have another baby to nurse and will make even more milk. The small amounts of hand expression will not do this, but pumping should be a last resort, only to soften a bowling ball breast so the baby can grasp the nipple or to relieve a crying-in-pain mother. Pumping hurts, too, when the breast is that engorged, so really is a last resort.

-          If there is ongoing pain or nipple damage, have a Lactation Consultant come and see if there might be a technical issue… the baby sucking on a lip, the baby not sucking properly, the baby having a tongue tie, etc. She will be able to diagnose the problem fairly quickly and get you on the road to recovery sooner than later.

-          Find support through La Leche League meetings. They are awesome. If you don’t like one group, go to another. You’ll find one that fits you perfectly.

-          Hang in there! You can do it. Nursing takes a lot of practice. But the practice pays off in a wonderful relationship with your child.

Saturday
Oct202012

Brewer Diet Be Damned

This could have been written to many people, but just happened to come up with the Hypnobabies course I am auditing. It's an issue with Bradley and any number of midwives and doulas as well. They ALL need to just stop referring to the Brewer Diet. It's crap. It's even dangerous to susceptible women. So while this letter goes to Hypnobabies, fill in the blank with who you know who uses the Brewer Diet; they need to dump it, too.

Dear Hypnobabies Folks, 

I’m sitting in on a Hypnobabies series and we’ve just finished the second chapter on nutrition. As you know, the chapter focuses on the Brewer Diet, Hypnobabies clearly advocating and recommending the Brewer Diet (BD) for those who take the course. As a midwife, I’ve followed the BD through many years, first through the Bradley classes as a student, then with peer pressure and finally, I started learning about the BD on my own because I kept seeing clients getting sick despite being on the BD, getting preeclampsia, including postpartum preeclampsia. I started reading studies about preecplamsia and reading about Pregnancy Induced Hypertension, opened my eyes to the amount of babies there were that were over 9 and a half pounds when their mom adhered to the BD religiously, bigger still, the more protein she took in. I saw shoulder dystocia over shoulder dystocia with these over-nourished babies. When midwives began talking about it honestly, we saw the same things and quit recommending the BD to our clients.

How did this diet come to be so ingrained in the natural birth world when only one doctor claimed it worked? There weren’t even studies that could replicate what Brewer claimed all that protein could do! For groups of people who demand evidence-based care, this is a glaring example of ignoring what we require of others.

For those that believe Brewer could do anything at all to prevent or help PIH or preeclampsia at all, you need to visit Preeclampsia.org and listen to what the women there have to say about The Brewer Diet. Here are the massive amounts of links the women have compiled that discuss the science of PE/HELLP/PIH.

None of this is to say I think a balanced diet isn’t important, but the Brewer Diet isn’t balanced at all. It is protein and calorie overload which taxes the kidneys and the body, especially during pregnancy. Women absolutely need protein during gestation, but not 80-120 grams a day as Brewer recommends.

What I would love Hypnobabies to recommend is a balanced diet of heavy on fruits and vegetables, quality protein, complex carbohydrates, water and minimal processed foods… what we all know to eat anyway!

I love Hypnobabies. I want to put everything I have behind this method. I don’t want to have to say, “Except for <fill in the blank>.” From what I understand, you’re changing the manual; I hope this is one thing you’re completely transforming.

With respect and admiration,

Barbara E. Herrera, LM, CPM

Thursday
Oct182012

Mucus Plug

Here's an awesome picture of a mucus plug pretty much completely intact. This mom was 9 centimeters when this came out. Her membranes were intact.

Photograph by Barbara E. Herrera, LM, CPM

You can imagine that if you "lose your mucus plug" pre-labor, it would be slimy and runny and you might have to wipe a couple three times. It also tends to keep coming out over a period of time, stretching out a little at a time over a couple of days even sometimes.

And just like when we have a cold and the body keeps making mucus in our nose, the body keeps making mucus in our vagina, too, so we technically could have more mucus plug again, though a complete other plug doesn't often happen. Mucus, yes. Plug, rarely.

Thanks to the mom for her permission for letting me use her beautiful plug to share with others. It's taken me years to get a picture of an intact mucus plug. I've held onto this for a couple of years so I could remove any hint of who the mom might be (even though I do have her permission). I came across it with the amniotic sac pic and here you go!

Saturday
Oct132012

Dripping Caul

  photo by Barbara E. Herrera, LM, CPM 

 

 

 

 

 

Friday
Sep282012

Hypnobabies Doula

I just became an official Hypnobabies Doula! To become one, I took an all-day course with a Hypnobabies instructor and then had to fill out an extensive booklet (that took several concentrated days to finish) and send in to Hypnobabies Central for grading. Apparently, I did a good job because I got an email saying I passed! Yay!

I am sitting in on my first Hypnobabies series starting next Friday night and already have my first Hypnobabies doula client. This is a fun adventure for me, learning new information as an experienced doula and midwife. I’ll report from the trenches.

Tuesday
Sep252012

Do You Like Being a Mom?

This is the most recent Facebook question I asked. Knowing how hard this question can be to answer truthfully, I made sure women could feel safe answering however they wanted/needed to, even if it wasn’t in the positive. One thing I didn’t say that I should have was it was a given that women loved their children, even if they didn’t like being a mom. You can see in the answers, the moms who struggle with the question, over and over professions of loving ones kids even in the face of the hardest times. I promise moms, none of us doubts you love your babies, even if you despise being a mom. I don’t think being madly in love with your child/ren and hating being a mom are mutually exclusive at all.

How would you answer this question? 

MCM: I love being a mom! So far I think I would say it's as wonderful, if not more, than I'd imagined.

KS: I can't imagine not being a mom. I love being a mom. There are days I don't like being a mom; it's hard. It doesn't feel rewarding. It brings me to tears sometimes. I have days I know I am not being anything close to the mom I want to be. But I wouldn't trade it for anything. The moments of sweetness and joy far outweigh and outlast any of the hair-pulling, hide in a closet ones.

NWW: No, I do not like it. I don't like it because of external influences. if it were just me and my daughter in a vacuum, it would be bliss. But society, American culture, has ruined it for me.

JT: Overall, yes. There are parts of being a mom I do not like.

SH: At first, no. I suffered from post partum depression/anxiety and it was debilitating for me. After the first year with both boys, I enjoyed it so much more but it was a slow process. I still have my days and I would not want any more children, but overall, yes. It is fulfilling, challenging, frustrating, exhilarating and I never knew I could have so much love toward two little individuals. My boys are 3 and 6.

TC: Yes I do. I like being needed and I like the intimacy of the child-mother bond. I like watching people genetically similar to me grow up. As the youngest child, I never really witnessed this. This also makes it really hard for me. I like that I am able to do it, even though it's really hard. I like the bond it has made between me and my partner. I like it quite a lot.

KO: Overall, I love being a mom. But some days, I hit my limit and I don't like it so much. It is especially difficult when my husband is not here to take some of the weight off my shoulders. However, I try to start every day with a clean slate and I have good days and bad days… but I do love being a mom and I certainly love my kiddos, even if I don't like the things they do all the time.

LSA: Overall, I do love it. I love seeing my little girl grow and learn new things. There are things I don't love about it, but the good parts outweigh the bad most of the time.

AH: There are days I do, other days when I really don't.

CAM: I cannot think of my life without my children! I love them unconditionally and they have gotten me through some very tough times because I knew they depended on me fully. That being said, life would be easier and much more carefree without them. I had children young, first at 20, second at 24 so I never had a chance to "party" but it also didn't appeal to me. At times, I do look at childless friends and think, “Oh, to have the money to travel without kids,” and such but my kids became my life and I chose this life! I look forward to traveling with them and showing them places! Their smiles light up my worst days!

EEC: I do like being a mom. I don't like the jobs that come with being a mom though- the endless cleaning and feeding and reinforcing rules. I wish I could source those things out some days and just have the cuddles and sweet moments. But, overall I do like, even love, being a mom.

AC: I found myself when I became a mom. I don't just love it, it is everything I am. Which isn't to say that it's the only thing I am. My favorite part of being a mother is that I will always be one, no matter what else I choose to become in addition to it.

LM: Yes. Now that she's 6 months old, things have gotten easier. The first little while was grim. Some days I miss the freedom of my old life, but I feel like I've finally embraced this new way of living. I love my daughter very much.

ALC: Being a mother is the most wonderful & the most heart-rending thing I've ever done. It's fun, sweet, delightful AND scary, frustrating, disappointing... my kids are a wonder to me- I love them in ways I never realized I could. But mothering itself is hard- pulls against my selfishness, takes time from 'fun' things that would be nice to do, but that aren't practical with kiddos... Being a mother makes me better, less selfish, more compassionate... like the marines (?), it’s the hardest job I've ever loved. Hard, but worthwhile....

SA: Yes. I may get annoyed with my kids and wish for a break, but underneath, I'm so much happier with them than I ever was without.

JK: More than words can express. But I also know it isn't for everyone or every situation. I love it a million times more being divorced and in another city than I did back "home" with my husband. Yes, I know that may sound bad, but it is the truth. Sometimes we are in a situation that makes it hard to focus on enjoying it because we are so miserable, and when we finally remove those unpleasant factors, we are more free to realize how amazing it is.

JEK: No. I really, really love my kids, and I enjoy their company the majority of the time. But I have trouble feeling patient with this stage of my life - there are so many other roles I feel I'm meant to play (midwife, writer, who knows what else), and I really look forward to those days, so sometimes it's hard for me to be content with "mom" being my primary role. I don't identify with being a mom in quite the way I expected I would.

On the other hand, it's a fundamental part of who I am, and I'm skeptical of anyone who says motherhood hasn't changed them in some way. I like myself as a mother, but I don't always like being a mom, if that makes even a bit of sense. So glad you're asking this question, Barb; it's something I've been thinking about a lot lately.

KPB: I love being a mother, but I don't always enjoy the work of parenting. Some days, I just want my kids to clean up after themselves without having to be coached, hop to as soon as I say it is time for bed, and fortheloveofbabyjeebus stop bickering about asinine crap and whacking each other. But they are reminders that they have their own aims and goals, and when I can let go of my agenda and be fully present with them, they are really neato little people with funny stories to tell and charming perspectives on the world. And i am fully aware that one day, they will likely not live at my house, and I will pine for the days when books and crayons littered my floor.

NM: I love being a mom and like a pp (?) I enjoy it even more now that I'm getting divorced. I can focus on my children and myself. But there are definitely times when I would give almost anything for a break, just a weekend off to recharge. But alas, it's just me and my boys and I think we make a great team!

DER: For the first 5 years, I hated it. My son has an "invisible" disability and I needed help. He was getting kicked out of day cares, preschools, play groups, etc. I begged his doctor for help, but she kept telling me how I was parenting wrong. "Friends" kept telling me I wasn't disciplining enough. Family had other obligations and couldn't help. He turned 5 1/2 and people finally started listening to me and finally gave me help. Now I do love being a mom! If those that could help me had listened, I would've loved it much sooner. All that wasted time missed out because even though I begged for help, often in tears, I couldn't get it.

JS-J: A very multi-faceted question. I love my children. I hate the drudge work. Most days, I'm glad I had them--but there are certainly days when I wonder: should we/I have done this? My chronic illness started well before my pregnancy, so I knew going in that my kids, for the foreseeable future, would have a "sick mom". I didn't realize how hard that would be. As I get sicker, it gets harder to parent. That being said, it's getting easier to be a mom.

Short answer: yes.

HJN: I love being a mom, love it. It is, perhaps like the way an endurance athlete loves her sport. The work, hard and the pay off, spectacular.

KM: Yes, but I dislike how it is now my only identity.

SBN: I do like it. I'm not naturally talented at it, and I work full-time as the primary breadwinner, so it is absolutely grueling, but I love being a mom even as it terrifies me.

PR: Mostly. I became a mom at 18, then had two more kids; and was a single mom most of the time (actually even when I was married, I was pretty much a single mom). I was overwhelmed sometimes with fear, fatigue and poverty. And I enjoyed helping the girls become thinking, responsible, effective human beings - although at some points they took a little longer and took a harder road than needful.  

As the girls grew up, other young women, at work mostly, turned to me as a mentor. I mothered these young women as I encouraged the bio-kids to become increasingly independent and strong in themselves. Then I ended up with a series of younger women to nurture - many of whom still call me mom.  

I don't get all ooey-gooey over kids. I do like babies, and I really liked being pregnant and giving birth.  

I look at the girls now, and am sad that they got tangled in the "oh I am a desperate sinner and am rotten" thing, rather than seeing themselves as a cherished creation who is loved. That is my deepest regret.

LA: I love it. I love seeing the world anew through my kids’ eyes. I love sharing in their excitement, their accomplishments, their exploration. I love seeing the amazing people they are growing into... from my 11 month old to my 15 year old, they are just amazingly neat people.  

Sure the daily grind gets annoying. I don't like dishes, laundry, bills, chores the kids can't remember to do, etc.  

Not gonna sweat the small stuff. Their lives with me are precious and fleeting. In no time they'll be gone, grown and I'll have a horribly empty nest.

MH: Sometimes I don't like it, but generally I love it. There are days when I feel like a horrible mother, because my patience is wearing thin. Sometimes it feels like a thankless job and the kids don't seem to care about what I do for them. Other days I receive huge rewards when I see them being kind to each other or people outside our family. I love to see them using the skills and morals I've tried to instill in them.

TD: I love it, but I don't always like it. But motherhood is certainly extreme. It's given me the greatest mushiest happiness I've ever felt and the most frustration, terror and sadness I've ever felt too. But I keep signing up for it again and again!!

APH: I think the quiet desperation of mothers is a dirty little secret that’s rarely spoken, because who wants to be called a bad mother? We feel guilty enough about our discontent as it is. And those feelings are compounded by our isolation. Women the world over share these feelings, not that they'd admit it. (this has many LIKEs)

JMY: It was the hardest thing I ever did. I love my kids but was not always patient and didn't really enjoy parenting when they were younger. Once they were teens it was a lot better. It's still very frustrating occasionally, and they are in their 20s now. But I wouldn't give them up for anything. I've never loved anyone with the intensity I love my 2 sons. I'd do anything for them.

JYP: I do like it, but wow is it hard work and some days it’s all I can do to not completely fall apart. I wish I had more support and help at home, that would help quite a bit. I have 5 kids, the oldest is 9 and the youngest will be 1 month on Sat. It's a big transition time again and that always make me question why I was blessed with so many children when some of my friends struggle to even have 1.

EE: I love the relationship with my children. The jobs associated with motherhood, not so much. I find that if I separate the two I don't get resentful.

RL: I like who I have become because I am a mom. The actual day to day process is very very hard, but I love watching them develop into who they are becoming. Overall, you have to look at the long term with motherhood. That's what it is about anyways. The trick is not to get lost in the difficulties of the day but look at the long term. That's where I find my greatest joy, both for who I have become and who my kids have become. It's about being involved in the process of creating and sharing in another's lives that has effects for generations.

CB: Hells yes I love it, it isn't the distinction of being a mom, I love those little turds. There are things that are hard, but that only shows my limitations (like dealing with individuating toddlers and homework for grade-schoolers, which is bs...). I wish I had more time to myself but that is temporary and at least we have the things we need even if right now I sometimes feel used up.

CM: I love it but man has my patience been tried (this past week especially!). I'm still at the beginning of my motherhood journey (22 months & 6 months) and I know there are amazing and challenging times that lay ahead. As you said, I often times have to remind myself that other "things" don't matter. I find myself frustrated that I can only do kids all day.... None of the other little things I may wish to accomplish for myself.

I've found myself trying lately to search for the balance of C as a woman/wife and C as a mom!!!! Being a lil bit of everything for everyone - including me! Whew! It's exploded my life like I imagined it would and I love all that it is presenting!

RL: I think more moms need to acknowledge and be okay with the fact that there are days we don't like. There are days when all you can do is function. And if you need help, for goodness sake get help. Even if it's just a babysitter. I feel blessed to be a part of a community where I feel like I have the ability to drop my kids off at someone's house for awhile when I need it, no questions asked. It's a fact that in our normal culture moms do not get much support. It's unfortunate because we need it. But like I said the big picture is different. To look back on how I've changed and how my kids have grown is very satisfactory. I wouldn't change it. But that doesn't make it any easier.

PG: I could write a chapter book but to abbreviate things: I had 3 babies in 2 1/2 years so I was either pregnant or nursing for about 6 years. The nursing really helped me to be patient, thanks to the oxytocin! I sure missed that after my last baby weaned. To put it as nice as possible, (seeing how this is a public forum) my husband was rarely available, wasn't very supportive, and we didn't get along so well then so the earlier years of my momhood were especially rough. Now that my kids are all adults we have wonderful relationships and they are my favorite people to be with!

SK: I fought so hard to become a parent (infertility) that people expect me to be over the moon and some kind of all knowing earth mother awash in 2 year old (She has been here 8 weeks) love and bliss. The reality is I have not been transformed into Mother. I am still the person I always was but now with less time, money, energy and sleep. Working to support her while going to school and parenting is proving to be a crappy job and one that frankly I am doing a crap job of. The pressure to transform into a better person and transcend the realities of day to day life bring me down and add another layer of guilt. No I do not love being a parent. This week I do not even like it.

SG: I love my daughter (she's 10) like no one else in the world. I would give my life for her in a nanosecond. I absolutely adore her and do everything I can to make sure she has a good life. That said, I do not like being a mother at all. I'm not good at it, it doesn't come naturally to me, I second-guess everything I do. I'm uncomfortable with it, and really glad that I stopped at one. I'm already worried about whether or not I'm going to screw up the one I have.

AKS: I love my kids. And sometimes I fantasize about running away, or hiring house elves to do the housekeeping, which I suck at. My girls are three years old and five weeks old, and I know that this is a season, and I may miss it when it's over, but it's intense in the trenches, you know? I have a great husband who is gone Mon. a.m. to Friday evening for work. When that changes, and I have help at night, I may feel less overwhelmed.

KWV: I love the relationships I have with my kids. They are rad little people who are endlessly entertaining. Bedtime, having to be the responsible one who makes dinner when I could skip it, remembering to buy the right kind of toothpaste, breaking up constant squabbles, enforcing the rules and henpecking so the chores get done- not so much. I am so much happier since going back to work. Even though I am working 12-13 hour shifts 3 days a week, I have so SO much more patience and energy for the skwids. I love them more than anything and our relationship is the most important one in my life, but the job of being "the mom" is one of the least interesting things about me and I don't think I'll look back on it as my most important life achievement.

JG: I love being a mom. But I am grateful that I can combine it with work and personal goals, in part because I have such an equal partner in parenting.

DG: I love the growth and maturity I’ve gained. I love my son. I love watching him grow. Do I love poopy diapers and and never being able to do anything spontaneous or on my own schedule? No. Some days, I enjoy it less than others and it is hard work, emotionally and physically, every day, but overall, yes, I do enjoy being a mother. I can definitely see how some might not enjoy it and I think we all have days where we just want to run away and forget our responsibilities.

DL: I really do like being a mom. I don't like my failures, my weak moments, the times I don't pay attention to my kids or don't want to play. I wish I still had the energy and gave the kids the time they deserve. I really do believe it's an honor to be a mom. I wish I could just not do the housewife part. By that I mean I want to be a wife, but not have the responsibilities of laundry and cleaning etc. I'd love to just spend family time all the time playing and helping my kids. Could I just get some people to do all the work around here and we could have fun all day?

NgM: These words from KS eloquently describe the intense angst being a new mom can be. While we all love our babies, it’s sometimes hard to describe the times we can’t stand them and wish they would just go away for a little while. Sure, a baby sitter might seem the perfect solution, but that can be cost prohibitive for many families, even when both parents are working. (KS, just like my daughter, is working from home.)

KS: I love my son more than life itself. But lordy, being a mom wears on me. I'm a very social creature and the first lonely desperate months with a newborn nearly sucked the joy out of me. My kid still doesn't sleep very well and I long for one God-damned night of uninterrupted sleep. I love cuddles and giggling together and watching him discovering new things. The tasks and indignities of motherhood--the incalculable amount of time I spend preparing meals that all promptly be tossed on the floor, responding to his fifth request to nurse in the past 20 minutes, the stepping on the sharp edges of baby toys at 3 AM when the teething toddler screams out in raging fury beast cries--these things make me think I was absolutely bonkers to skip willingly into this parenting gig. On those days where it's 2 pm and I'm still in my pajamas and my son has already watched four hours of TV because I have a deadline for work I need to meet and we're both starving and there's no food besides graham crackers and goldfish crackers and he screams at me because I had the temerity to reclaim my smartphone, I think I will completely lose it and end up a headline. Most of the time, it's great, but those bad days make my worst days of work or school look like picnics. And unlike school or work, I can't call in sick to motherhood. The grind can feel unbearable.

LC: I love being a mom. I have given up a lot of things to be a full time mom right now and there isn't a day that goes by that I actively wish I was out in the work force or in school full time or something like that. I actually get a tight feeling in my chest every time a doula client calls, because I know I'm going to have to drop everything, pawn the kids off on a friend, and be absent for who knows how long. I wouldn't trade my mom status for anything. But... I feel quite often that I'm not really very good at it. I'm impatient, I yell, I let my kids play by themselves for hours because I enjoy getting some "me" time. I like baking and cooking but I don't like little helpers in the kitchen, and I feel guilty about that because I know other (better?) moms let their kids help and have fun and learn. I like it when they are creative and turn a box into a boat and all the pieces of the games and puzzles into ocean plankton, but then I start fussing about the mess while the joy of the game they made up is fresh. I hate that I do that. I don't want to be a soul crusher. I love so much that my husband's job allows me to stay home with them because I think I'd be the worst daycare mother on the planet... always forgetting stuff for show and tell and snack time and Halloween day, etc. And I WANT so badly to be their person, the one that listens and hugs and laughs and is a source of joy to them, but I really wonder if to them, I sound like the Charlie Brown teacher in the background, nagging, fussing, uh huh ing... So. Yes, I like/love being a mom, at the most basic "I love my children more than life itself" level. But I feel quite sure most of the time that I'm massively and unknowingly screwing it up, big time. I wish I had the confidence that I was GOOD at it; that would make me like it even more.

NgM: I wrote to LC: “You are the EXACT kind of mom I was... and my kids are AWESOME adults. Do not give it a second thought, worrying your kids will turn out to be anything less than stellar because you don't like them helping in the kitchen. I tried to cook when they were sleeping because I didn't want them in there with me. (Don't I sound like a horrid mom?! Thank goodness we have Exhibits A, B, C & D to show I wasn't.) I was not an artsy mom, either (and have written about that a lot), not an on-the-floor mom, but a reading-on-the-couch mom. It takes all kinds; we're just different.”

MD: I love being a mum, but it isn't my day job.

ESG: Yes, I like being a mom. I love my five children. I, too, struggle with patience and yelling. Of motherhood, mostly hate the drudgery, the mundane-ness -- even as I struggle as a homeschool mom to make their lives NOT mundane -- the constant Sisyphus-like battle with laundry and dishes and cooking. Sometimes I think, "I'd love to outsource some of this." But if I wasn't the one who kissed toes during diaper changes, or rubbed stain-eraser on Tae Kwon Do uniforms, or made sure blankets were on the right beds, would I feel so close to my children?

NgM: Do I like being a mom? You bet. My kids are my best friends, we share the closest secrets and the most hilarious family stories. While I never wished any age or stage away as they grew up, I really do love them as adults; they’re great! For those in the middle of the hard stages, I promise, in a minute, they will be adults. It really does happen so fast. (Some days, I know, not fast enough.)

I loved this question and loved that women answered so honestly. Thanks to all who participated. It was extremely tender and very enlightening. 

Meghann, Darren, Aimee & Tristan

Friday
Sep142012

Trevor & the La Leche League Battle

This is getting out of hand. I cannot believe the hoopla Trevor has created regarding his desire to be a LLL leader in Canada. For those who don’t even know who or what I’m talking about, I’ll start at the beginning, but I’m going to give the short version.

My own prejudice first. I was a LLL leader for ten years. I also happen to be lesbian married to a transman. I had three children I breastfed for years and my partner, then presenting as a woman, had a baby that he also breastfed for 2.5 years. This topic isn’t foreign to us.

Trevor came out as a man and had his breasts removed (Top Surgery… Bilateral Mastectomy). Then a few years later, with his genitals and female insides intact, decided to birth a baby. Once the son was born, he wanted to breastfeed. Trevor says he has milk, but it’s hard to say how much since he uses an enormous amount of donor milk (16 different donors by the time his son was 7 months old, so he says in his blog Milk Junkies) and from what I know of Top Surgery, most, if not all (female) breast tissue is removed and the nipple is (usually) completely removed and replaced (women’s nipples are very different than men’s, even if women are AA sized), making the milk ducts all but inaccessible. If he has any milk at all, it would almost be a miracle of science and possibly a malpractice of his plastic surgeon. To feed his son, he uses a Supplemental Nursing System (SNS) to give the donated breast milk. Trevor started going to LLL meetings and eventually, a LLL leader friend thought it’d be good for him to lead support meetings which led to his wanting to be a LLL leader and his applying. Because he is a man, he was turned down. LLL is a mother to mother organization and Trevor identifies as a man.

Question: If Trevor was born a man and was “breastfeeding”, would he be as welcome at meetings as Trevor? Or is Trevor really being seen as a woman and that is why he is so accepted? I believe it’s the latter.

Trevor’s invading women-only space does an enormous disservice to both transmen and LLL alike. Why is it so important to have every. single. place. be both male and female? Why can’t there be male-only and female-only spaces? Is being politically correct really that important? Still?  

You can read LLL’s requirements for becoming a leader here. It’s clear the roles of mother and father are delineated. Some might find this sexist and that it’s just not keeping up with the times of the science of possibilities, but can’t there be a place where mothers are permitted to just be mothers? Is it gender bias to request that women have a space where men aren’t looking at intimate areas of women’s bodies? While Trevor says he has had no problems at his group, I know there are plenty of women who would never attend meetings if he was a leader (or any other man for that matter). As it is, when guys hear that Zack and I got together at a LLL meeting they are not happy, thinking that they never had to worry about the meetings being pick up spots (not kidding; we’ve been told this on a number of occasions). Men can become Lactation Consultants or Peer Counselors and hired on a one-on-one basis, but can’t LLL just be a place for mothers to come in a group setting?

But, there are other issues that come into play that disqualify Trevor from being a LLL leader. LLL is extremely clear about not mixing causes and it doesn’t take two seconds on Trevor’s blog to see that two of his causes are milk sharing and Lesbian, Gay, Bisexual, Transgender, Queer, Intersex (LGBTQI) issues. LLL has very strict limits on milk sharing and wrote Trevor about it, which he published here. They say:

A Leader shall never initiate the suggestion of an informal milk-donation arrangement or act as an intermediary in such a situation. If a mother wishes to discuss these options – which may include donating expressed milk, wet-nursing or cross-nursing – the Leader’s role is to provide information about the benefits and risks, as mentioned above, including the limitations of home sterilization of expressed breast milk.

Regarding being a specialty leader such as an LGBTQI leader, they say:

I would also like to address your interest in leading an LGBT LLL meeting. I think that it is important for you to know that we do not accredit specialty Leaders. So for example Leaders often say that they need a working mother as a Leader for their Group because she can relate to the mothers in the population the Group serves - I would disagree - what qualifies a Leader to relate to those mothers is her experience of mothering, not her experience of separation. Similarly in this case it is the experience of mothering through breastfeeding which qualifies a Leader to help others. Any Leader can help anyone who is interested in breastfeeding. LLL has accredited a number of lesbian mothers as Leaders. They lead Groups for all mothers.

While LLL initially turned Trevor down (in the letter above, they have since written a statement saying they will look at the issue that has never been presented to them before. This is where I get testy.

A letter of “support” was written that could be cut & pasted or signed and sent to LLL and that letter began:

As the world's most important breastfeeding support organization, it is vital that you include all kinds of breastfeeding families. Regardless of any other issues, LLL should support breastfeeding relationships. I was very disappointed to hear that a transgender dad in Canada was told not to apply for leadership because of his gender identity.

Excuse me? LLL supports ALL families. LLL does not exclude any families from their support, knowledge or information. LLL also did NOT tell Trevor not to apply for leadership. It explained to Trevor why he was not a good fit for leadership, the same way they tell women every single day why they are also not a good fit, either. Some who apply are; most who apply are not. And this is just how the letter began! In this angry tone. What the heck?! This makes it sound like LLL is a vile organization that has unreasonable concerns about trans issues, namely transphobia when, by every bit of correspondence that Trevor shared (without LLL’s permission, I might add), you can see that LLL is extremely respectful and kind. Why Trevor and his spouse decided to write the letter in this tone is beyond me, but it has pissed me off more than any other aspects of the whole topic.

I’ve said in various threads around the Net that if Trevor wants to lead the specialty breastfeeding groups, he will be amazing at it! No, he doesn’t just need to limit himself to LGBTQI groups or milk sharing or SNS groups, but those can definitely be his focus and forte just as each of us midwives also tend to have specialties, too.

Trevor is definitely traversing new ground and it’s awesome that he is. It needs to be tread, but I don’t believe it needs to be tromped on through LLL’s land. I would love to see him start his own organization and I would be one of the greatest supporters. I am all for trans procreation and breast supplementation… fabulous! Zack and I are both on the same page with this issue.

Leave LLL alone, Trevor and others; find another avenue for your energies… something positive and joyful. We have enough fighting in our lives. I don’t believe we always have to shove ourselves into middle of the road organizations, especially ones that are single sex only spaces.  Let’s create something for us… just for us… and show the world how great we are and how strong we can be. There’s more than enough to go around.

Thursday
Sep062012

Dr. Biter in the Union-Tribune

Encinitas Physician Penalized: Repeated negligence occurred, state says.

This, of course, was all before the baby's death July 1, 2012. I pray the Medical Board does something about that as well.

Tuesday
Aug282012

Biter Baby Death on the News

The family that lost the baby with Dr. Biter was on the news last night discussing their being upset about Biter signing the judgement with the Medical Board on May 15, 2012 and it not going into effect until Sept 7, 2012... and their baby died July 1... that something is wrong with that time frame.

You can see the NBC News Report here.

Friday
Aug172012

Dr. Biter Judgement Posted

Public Record Action(s): Limits on Practice

                                           Probation with Suspension

The Limitations Include:

- Suspended from practice for 60 days

- Has to take a Prescribing Course and has to pay for it and it doesn't go towards his CEUs.

- Has to take a Wrong-Site Surgery Course, has to pay for it and it doesn't go towards his CEUs.

- Has to take a Medical Record Keeping Course, has to pay for it and it doesn't go towards his CEUs.

- Has to take an Ethics Course, has to pay for it.

- Has to take a Clinical Training Program, has to pay for it and it doesn't go towards his CEUs.

- Has to be Monitored by an OB who he's not ever worked with and he has to pay all costs for the monitoring for the entire 7 years of his probation. The monitor is to be with him at all times he is practicing and to submit quarterly reports for the duration of the probation.

- He is not allowed to practice in a solo practice even if that is in a practice with others in the same office. He is required to always be in a multi-practice.

- He is not allowed to be overseen by Physician Assistants.

- He is not allowed to operate in any home unless there is another legal OB/GYN there with him.

- He is not allowed to leave CA for more than 30 days without letting the Medical Board know about it.

- There are several different pieces about non-practice... periods of time of if he's not practicing he has to announce it to the Medical Board and forfeit his license.

- He has to pay for all costs of probation monitoring.

- He signed this on May 15, 2012. The fetal death was July 1, 2012, but this probation doesn't go into affect until Sept 7, 2012.

So, there we have it.

Tuesday
Aug142012

NBC’s Treatment of the 2012 Olympics

Zack and I love the Olympics and watched an inordinate amount of them the past few weeks. What we saw we loved, but there was so much we didn’t see and that’s what I’m writing about. Just some thoughts.

-         The most obvious thing NBC did was to highlight the athletes who had VISA contracts. If the swimmer or runner did a VISA ad, NBC watched that athlete from the first trial to the last note of their national anthem. If they had minor ad contracts, like McDonald’s, you’d see them somewhat, but not nearly as much as if they had major contracts. What’s up with that?

-         It was days and days before we realized the “minor” (minor = less publicized) sports were being aired during the daytime hours, often even live London time. Things like Archery, Fencing and Synchronized Swimming were found eventually there in those daylight shows, sometimes on the NBCSports station! Why they didn’t bother to tell us this on the main NBC channel is beyond me.

-         I like watching the Olympics in large part for the, what I call, Heart Stories. You know, those tender, heart-wrenching stories of overcoming adversity in order to stay alive and get to the Olympics? Those. Sadly, this year, there were very few Heart Stories. I can only remember a handful and that’s way too few. I am sure there were many, many more Heart Stories at the Olympics. What were they and why weren’t we told them?

-         Why aren’t things like racial disparity discussed on tv? Why isn’t the obvious like there are no Ethiopian Equestrian teams and no Queen’s granddaughter running Track and Field a topic of discussion? Is money the deciding factor?

-         Wouldn’t it be fantastic to know how dancing horses are considered a sport when baseball and softball are not? How about Target Shooting? Aiming and pulling a trigger? A sport?

There you have it. Some of our pressing concerns. Did you have any?

Thursday
Aug092012

A Doula's Role?

Patrice Nichole Byers of Birth Your Way wrote a great post entitled, “Doulas and Advocacy: Are they mutually exclusive?” In there she discusses the role of doulas and whether speaking out for the mother during birth is an appropriate thing to do or not.

“I hear time and time again. I'm sitting in an interview with potential clients and they tell me that one of the reasons they want to hire a doula is to have someone advocate for them in the birthing room. I'm constantly explaining to clients that while I do consider myself an advocate of choices in birth, natural birth, and natural postpartum choices; I do not advocate for you during birth, but rather help you to advocate for yourself.”

I’ve also heard women say they want someone to “advocate” for them in labor. What I’ve learned they really are saying is they want someone who will speak up for them so they don’t have to. When women are in the throes of labor, it’s understandable they don’t want to be the one to disagree with the nurse or doctor. How appealing to have someone else be the heavy, deflecting any of the negative energy that might be coming from the medical personnel, allowing the laboring woman more peace to work her birth.

But when a doula opens her mouth with “She doesn’t want that,” it all too often sounds like the doula is directing the labor, not the woman herself. Especially if the client is wrapped up in her labor and doesn’t affirm what the doula said, the doula really does begin digging a hole for herself, credibility falling precipitously into the chasm.

If the doula was only saying “She doesn’t want that,” it might not be so bad, but it’s far worse as Patrice continues:

“I'd hear over and over about stories of doulas who would get into heated conversations with doctors and nurses about hospital policy, clients wishes, evidence-based practices and more. I'd hear doulas brag about arguments they felt they won, shouting matching, standoffs, and more. The worst to me are the stories of doulas who unhooked IV's, stopped the pit machine, and spent time interpreting fetal monitor readouts.”

You’d think these rogue doulas are rare, but from talking to my nurse friends (who are extremely doula and natural birth friendly), they are not. Many doulas seem to see their role as adversarial instead of supportive. That attitude alone sets the client up for a negative experience. Not that it’s always bad, but cooperation works much better for women than hiring a body guard.

If a woman feels she needs a body guard, if she’s in a state with legal midwives and can find one with impeccable education and skills, she should look elsewhere to birth. (I know, that’s a lot of “ifs.”)

I don’t have a perfect answer for the women who do feel they need to hire someone to speak for them. Perhaps in their experience they aren’t very vocal in labor or they want to immerse themselves in Labor Land instead of remembering, as one woman recently said, to try to remember “intermittent monitoring, not continuous.” In these cases, I would say the burden falls onto the partner. I usually encourage the other parent to let go and be in labor, too, that they don’t need to stand guard over their wives, questioning every move the nurse makes, but perhaps there is a place for a Bradley course after all.

I’d love to hear what doulas and women have to say about this topic. Thoughts?

Monday
Aug062012

Gardenias

A client gave me a gardenia the other day. I love gardenias. They are so beautiful! Their scent, the thick white petals, the copious amount of blossoms on the bush… just lovely. I kept the flower next to me until it turned into a smooshed brown mass of deadness that no longer smelled sweet before throwing it out. Until then, though, I had to have smelled it a hundred or more times a day.

There was a time I was going to change my name to gardenia… lowercase g, no last name. I actually went by gardenia for about three years, determined to legally change my name once I’d finished midwifery school in 2002. I did worry about the difficulties of having only one name, telling people only a lowercase g and no last name, but I just loved gardenia so much it seemed worth it to me.

I hated my Barbara name in English. It was so old. Barbra. Ugh. Just so old sounding. I was named for my Nana, who I loved and who my mom adored and I knew if I changed my name it would break my mom’s heart, but I just really hated my name. And my middle name was even worse! Ellen. Blech! Now, Barbara in Spanish… that was nice. Savage. I liked that alright. But it didn’t have the same connotation in English. In English it meant old lady.

So, I was in midwifery school in El Paso, Texas where I spoke Spanish 99% of the time, even dreamt in Spanish, and was gardenia this and gardenia that. During one long labor, an older abuela took me aside and asked me if I knew what the gardenia was in Mexico and I said I didn’t. She whispered that it was the Mexican flower of death and I was mortified. What was I to do?

There really wasn’t anything to do but go back to Barbara which, suddenly didn’t sound so bad after all. Bárbara, the feral midwife… could I live with that? Better than gardenia, the midwife of death, right?

After that night, I never looked back and have always been Barbara… or rather, Barb. And as much as I didn’t like it before, I love it now!

Maybe I just needed to grow into it.

Monday
Aug062012

Gentle Grandmothering

As I approach my first completed year as a Nana, I have some thoughts about what it’s meant to me to be a hands-off grandmother. I was initially surprised when Meghann invited me to her birth and early postpartum period, thinking she would think I might meddle, but really glad she knew I wouldn’t. I ended up at her home for one week before the birth and five weeks after; it was perfect.

Meghann had some nursing challenges, some of which I was able to help with, others of which we needed others’ knowledge to solve. I didn’t feel any territorialism at all when she reached out to the Lactation Consultant or Pediatrician when the limits of my expertise had been exceeded, although I could see how other mothers, especially midwife/doula mothers could feel that way. I believe it takes a great deal of maturity that comes with years (and I have puh-lenty of years!) to be able to set aside that know-it-all belief and allow others in to help when their help is needed. If you as grandparent are able to do so at a younger age than I am, good on you, but I honestly believe I would not have been able to do so much younger than I am now.

When I was at Meghann’s those early weeks, I had my own room on my own side of the house and was careful not to overstep my boundaries, being where I was needed, going where I was asked. When things got harried, Meghann was texting me in the middle of the night and I was going to her to help her get latched on and make sure things were the way they were supposed to be, but otherwise, she and Brian were on their own, nursing, changing diapers, all the new parenting things… unless they needed extra help. I was there and more than glad to assist, but didn’t want to interrupt their parenting time; I know how precious it is.

What I did do was all the stuff that falls through the cracks. I changed the bed every day. I cleaned the bathroom twice a day. I made sure the trash was empty several times a day. I did the laundry continuously. When Meghann went to the bathroom, I straightened the area she was sitting/sleeping in in the living room. I made sure there were diapers for the baby in the area where she was. Brian was more in charge of food for her, but I would clean the dishes and kitchen when necessary.

By the time I left, they were pretty self-sufficient with everything I had been doing and I felt comfortable going. Of course, I wish I could have stayed longer, but I was glad Meghann and Brian were doing so well. They had transitioned to parenthood so beautifully.

While home, I would still get questions every once in awhile, but more likely, I would hear about how the new family was doing things. I remember hearing how they had read “Baby-Led Weaning” and were going to feed Gabriella that way instead of the La Leche League one food at a time way my kids had. It took a few minutes of “What?! You’re not doing it my way?” But, I listened to Meghann and read online about the method and was proud that I could grow and change even after all these years of something so new and different. When Gabby began eating the newfangled way and there were no untoward effects, I could breathe easy and chuckle inside that Meghann was, in fact, doing everything right. Still. Still doing everything right. She really is such a good mom. And I tell her as much as often as I can. I am so proud of her, listening to her instincts, learning new ways the way I did back when I was a new mom.

Recently, Meghann started Juicing and as I questioned her, we did this dance of my asking questions and she answering. I work hard to be respectful, not shoving her against the wall, forcing her to be defensive and angry, but giving her the space to explain what she is thinking and allowing her the time to let the story unfold. I could be snotty and judgmental and create a place of discomfort between us, but what would that serve? I want to keep things between us close and friendly. I have a vested interest in having things good so I can see my granddaughter often and in a positive environment. I don’t want my relationship with my daughter or my son-in-law to be negative or uncomfortable ever; I love them! And don’t I want to be nice and kind to those I love? Of course I do.

I’m about to visit again in a couple of weeks to be there for Gabriella’s first birthday and I want to make sure I don’t step on Meghann or Brian’s toes as far as parenting goes. I always want to defer to their wishes while sharing my ideas and thoughts along the way if they’re interested. One way I ask if they want to know my opinion is to say, “Oh, that’s new to me. We did it such-and-such a way” and leave it open to them to discuss it if they want to. If they don’t want to talk about it, we don’t. I don’t say, “Why don’t you do this?” or even, “Why don’t you try this?” because this is their baby and they get to raise Gabriella their way. I got to raise Meghann my way; now it’s their turn with their baby, no matter how much I might want to do it my way or might disagree with what they are doing. (Which I am not disagreeing with at all.)

There have been a couple of topics that needed to be discussed (usually mother/daughter topics) and I decided to email Meghann instead of talking over the phone and that worked great. Both of us being writers, it is a method of communication we’re comfortable with. Others might feel better talking on the phone, but email works for us.

What if I did ever step over the boundaries of being a too nosy grandma? Poking my business into theirs too much? I would hope Brian and Meghann would feel comfortable telling me, without hesitation, that I am offering advice where I wasn’t asked for any. Both my daughter and son-in-law are so kind and gentle they would never be rude, so I know they would do their best not to hurt my feelings, but I want them to know their family comes first, not my feelings. I’ve told them they can tell me anything at any time and I would be open to listening to what they had to say. I would hope they’d like to hear what a voice of experience has to say, too, but that ultimately, the choice is theirs and I am to understand that.

I think that this understanding right from the start makes things easier. There aren’t any hidden agendas or manipulative schemes between us. The clearer the communication, the better the relationship.

As I move towards the second year as Nana, I hope it goes just as smoothly as this first year did. I hope that Meghann feels as comfortable asking me questions about childrearing as she has and at the same time exhibiting her independence as a new mom as she does. She and Brian are amazing parents. They make great decisions together and I support them whenever I can. I’m just glad they support my place as maternal grandma. It’s a unique and wonderful place I wouldn’t trade for anything. 

Tuesday
Jul312012

Cesarean Scar: Emina's Story

My due date was April 26, 2012 but on the morning of April 20th, I woke up with contractions. What seemed like "fake" (braxton hicks) contractions, I was going to find out soon that they weren't fake. I waited an hour and they seemed to get worse. Finally I went to the restroom and saw that my mucus plug came out. When I saw that, I called my doctor and she advised me to come into her office right away and she would check me out. 

When I arrived to her office, she took me in right away. She checked me down there to see if I was dilating. She told me I was 2cm dilating and should go to the hospital now and register. I will never forget this day because not only was this my first child coming into the world but I was also terrified of giving birth. I was so out of it, that I ended up driving myself to the hospital, registering myself and walking myself upstairs to the maternity floor. I had already called my husband, my mother and father, my in-laws, my brother, my brother in law and sister in law... EVERYONE. They all yelled at me asking why I would drive myself to the hospital ( at the time I did not know why I did either ). 

I checked into my room at about 12:30pm, which was next door to a young women who I work with, that had given birth the day before (such a coincidence). She had given birth vaginally and explained how she was so sore down there. But she told me that she had gone 8cm without an epidural until she finally needed it. Also explained to me how the birth was not bad at all (her baby was 6lbs-ish). She calmed my nerves a bit but I was still so, so scared. 

Finally, after being in my room for 15 minutes, my mother arrived and she was in tears. She was excited and scared for me. She said she didn't like to see me in pain. My contractions were bad. They were 3-5 mins and they were painful. Within the next few hours I had my whole family in the room with me, while I was going through experiencing these painful contractions. I was walking around a lot, because I wanted the labour to go quickly. I was doing stretches and anything possible to get the birth going. 

After about 4-5 hours in my room, my doctor came in to check my status of the dilation. I was 4cm dilated and I was 60% effaced. I was still feeling these bad contractions but did not want an epidural until I was closer to about 8cm. Everyone was watching me in pain. Although I was in so much pain, I had a smile on my face the whole time. My family was making me laugh, walk, talk a lot, stretch out. It was a soothing experience to have everyone there. After another couple hours passed by, my doctor came to check on me and I was at 5cm dilated but still not effaced 100%. 

After an hour of being 5cm dilated, I couldn't take the pain anymore and my doctor suggested an epidural to try to get the birth process moving. I agreed to the epidural, even though I was also terrified of the epidural. I was shaking a lot when the anesthesiologist came in to give me the epidural. My husband was in the room with me and kept comforting me that I would be fine. They did a great job that I didn't feel anything when they stuck the needle in. It was like a tiny pinch and that was it. After the epidural, I felt GREAT! I felt so confident in giving birth. But, after a couple of hours on the epidural, the doctor had checked me again and said I didn't move from the 5cm and also my baby's heart rate was really high. She said she would give it another 30 mins and if nothing changed then we would have to take about other options. 

I felt my baby move A LOT, she was kicking like crazy. Everyone could see my stomach shifting a lot. I saw her foot prints a couple of times on my tummy, that’s how hard she was kicking. After 30-30 mins of waiting, the doctor checked again and of course I did not shift away from 5cm and at this point the head was basically stuck at my pelvic bone. The doctor said that the baby’s heart rate was getting really high, and my BP was getting really high, also the baby was basically stuck at my pelvic bone and if I gave birth vaginally, the baby would probably break my pelvic bone. So, she said I had no other choice but to have a C-section. When she told me I would have to have a c-section, tears poured down my eyes like a waterfall. Throughout the whole pregnancy, the thing I was most afraid of was having a C-section. My husband took my hand and told me everything was going to be fine, and that they wanted the baby to come out safely that's why I have to have a c-section. 

It felt like a knife went through my chest when they told me I had to have a c-section. My husband was so kind and loving. He encouraged me to go into the OR with a lot of confidence. When I got to the OR room, my hands were shaking uncontrollably. I was terrified. They prepped me up, cut me up and in came my husband. They said I would feel a lot of pressure but no pain. The process lasted pretty quickly and I felt EXTREME pressure, it was actually very painful for me. All of a sudden the doctor got the baby out and I didn't hear a cry, all I heard was,"OMG." When I screamed out," WHAT??? WHAT OMG??" The doctor said," Omg, the baby is HUGE."  Then I heard her cry. Everyone was cheering, my husband was in tears. I was crying and overwhelmed and didn't feel anything at that moment because I wanted to see my little ( or not so little ) baby. My husband came over with the baby and she was BEAUTIFUL. He said, "Babe, she is 10 pounds and 1 ounce." And I was shocked. I thought to myself OMG, no wonder she got stuck at the pelvic bone, she is a BIG, BIG baby. My whole family could not believe how huge she was. 

After staying in the recovery room, I finally got to hold my baby and kiss her. It was a surreal moment but honestly, I wouldn't change it for the world. Although I was disappointed that I hadn't given birth vaginally, I was extremely grateful that my baby came out safely and perfect. All I wanted was for my baby to be ok, whether it was vaginally or c-section, at the end of the day I was glad and never bitter about my c-section. 

When I touch my scar, I feel powerful. C-section is a major surgery and a birth at the same time. Although I am not fond of having a scar, it represents my baby and me. I was a strong women to be able to go through this birth, any way it happened. I am never bitter about it. I am more than thankful that my baby came into this world safely. Although I ended up going into Congestive Heart Failure 2-3 days after the c-section and ended up getting Post-partum cardiomyopathy, the experience was still great. I am thankful for life every day, especially my baby’s. My life is precious and every moment is a blessing to me. The fact that I can hold my baby and see her beautiful face every day is a gift of God. I thank God every day for my daughter and for my own life (since my own life hung on a very thin string). No matter how you give birth, be thankful for your baby and yourself. I love my scar, it’s a sign of strength. I love my baby, my life, my family and I love the fact that I can sit here and share this story with everyone. Never look down upon yourself, instead be grateful that your baby came into this world, which a lot of people take for granted. 

Hope you enjoyed my story and the birth of my beautiful little Ariana. God Bless!

Saturday
Jul282012

Making a Hospital Birth Plan

Interestingly, I’ve been asked about this post several times in the last couple of months, so thought I’d re-post it. While it was originally written in 2008, very little has changed. I only removed the note about episiotomies since they really are done so infrequently now. If they are still done where you live, feel free to add a line about prefering to tear to an episiotomy or an episiotomy only for emergency reasons. Otherwise, I found it surprising how identical the plans were even four years apart, yet they really are the same.

I've also been asked if this can be shared in childbirth classes. I don't mind as long as you attribute it to me, please, with my blog's url, too. I'd also love to know if you're using this for your clients. And, to those that have, thanks for asking.

Birth Plans on the Internet are woefully out of date. So many "interventions" (and your avoidance of them) are routine they don't even require a mention on your paperwork. Feel free to delete any of the items on this list if it doesn't apply to you, but be very judicious when adding anything else.

Onward....

_________________________________________________________________

My Birth Preferences List

I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence. When possible, I request that procedures be explained thoroughly (benefits and risks) and also, when possible, I would like to be included in the decision-making process.

Below are items that are important to me. Your help with these is very much appreciated.

All of the requests are for a normal labor, birth and postpartum period.

Labor

- I would like to have as natural an experience as possible - freedom of movement, intermittent monitoring, a saline lock instead of an on-going IV and food and drink as tolerated.

- I prefer to bypass using the Pain Scale. If it is required for your job, please assign a number to me from your experience.

- Being in the hospital, I know pain medications are available. Please accept my request that medications not be offered to me. For personal reasons, I am striving for an unmedicated labor and delivery. If I desire medication or an epidural, I will be the first to ask for it!

Birth

- Please do not direct my pushing with counting or yelling "Push!" to me.

- I would like to be as active in the birth as possible, including bringing my baby up to my chest.

Cesarean

- I am not squeamish and would very much like to watch the baby be delivered as much as possible.

- Please use double-layer sutures when repairing my uterus.

- I admire Baby-Friendly Hospitals and would like to create that type of environment as much as possible. This includes having the baby skin-to-skin (as health permits, of course), keeping the mother-baby dyad together during the repair and recovery and encouraging unlimited breastfeeding, even during the initial recovery period.

- If my partner leaves the operating room with the baby, I would like to ask if my doula might step-in to help me during the repair.

- I would like one of my major support people to stay with me at all times in recovery.

Baby Care

- No Erythromycin eye ointment, please.

- No vitamin K injection (unless bruising or birth trauma occurs).

- No vaccinations are to be given at this time.

- We want to give our baby his/her first bath and understand you might have to wear gloves when handling the baby. This is an acceptable compromise to us.

_______________________________________________

There you have it! Simple and succinct. Keeping the Plan short increases the possibility that it will be read.

One of the issues that arises is when parents don't know why they are asking for certain things on a birth plan. I'm going to outline each item on the Birth Plan and explain why someone might choose to do (or not do) the procedure or intervention. I will also explain why I worded the item the way I did because I think it's important to know the reasoning behind the sentence structure as well as the reasoning for its inclusion.

Labor

- It might seem odd that I make one item filled with so many interventions, but declining/altering the procedures mentioned are very standard when a woman presents a birth plan to the hospital staff. I believe just dashing through them quickly, getting the "typical wants" out of the way, helps the staff to see that your next items will be different than the typical Internet birth plan template.

Asking for a saline lock lets the staff know you understand that progress in labor and delivery no longer includes "Hep"arin Locks, but they are saline locks nowadays.

- The Pain Scale is increasingly becoming a bone of contention with natural birthing women because with it comes the presentation (or encouragement) of medications and/or epidural for pain relief. The higher the number on the Pain Scale, the more insistent staff can get regarding accepting pain relief.

I suggest the nurse assign her own number based on observation because it is a requirement for hospitals to use the Pain Scale with patients. Here is what the Pain Scale looks like.

- Nurses tend to frown on women asking not to be offered pain medications. I believe it can be very uncomfortable for a nurse to see a woman in pain and not do something about it. The desire to help women is strong... and not being able to help - not being comfortable witnessing a woman without pain medication/an epidural - can be a very real cause of (di)stress in nursing staff.

In saying "For personal reasons..." there cannot be any sort of challenge regarding the request without stepping on a woman's feelings - and feelings are harder for people to trample than (what is perceived as) random wants.

Birth

- The tendency to holler "Push!" to a woman in second stage comes from when women were given a heck of a lot of medication and couldn't follow directions very well (back in the 40's. 50's and 60's) and the ritual has remained, most would say because women who have epidurals need direction to get the baby out. Many of us see the world of difference between giving direction and yelling. To me, the shouting becomes hysterical (not the funny kind) and sometimes filled with angry energy, exhorting the woman to try harder, "Push harder!" - as if she isn't doing a good enough job.

Even when women need to be directed in how to push, either for the baby's safety or because the woman is so numb she can't feel what she is doing, those around her can do this without the cheerleader effect so often found on labor and delivery floors. Asking politely in the birth plan lays out this request.

- Many Birth Plans will speak about being physically active and wanting to push in any position. Because that request is so common, I thought I would wrap that with the newer request for the woman herself to bring the baby up to her chest - to "help deliver the baby" if you will. If you don't want to help bring the baby up, just eliminate that part of the sentence, but if you want to have freedom of movement during second stage (pushing), I encourage leaving the first part in... and worded that way because "I want to be able to assume any position I want during pushing" will be frowned upon and discouraged - they hear that a lot. Worded differently, they will pay attention in a different way.

Cesarean

- It is very important, if you want to watch your baby delivered, to tell them you are not squeamish. If you are, DO NOT ASK FOR THIS ON YOUR LIST! The last thing they need is you to freak out or vomit in your incision, so think long and hard about watching your baby born. To be honest, being able to see much is rare because the incision is tucked under your belly. If they were willing to bring a mirror in, that would be an entirely different experience.

If your partner stands, they have a better chance of being able to watch the baby born. If the hospital is okay with photographs, before going into the operating room, ask if the person with you will be able to take a picture for you as the baby is born. Most will say no, but it is worth asking. I would highly suggest taking the camera into the operating room and when the doc says they are starting, ask again if you can take a picture of the delivery. Some nurses will say "No" whereas the doc will say, "Sure!"

When the baby comes to the mom, ask the anesthesiologist to take a picture of the three of you! See this picture taken by an anesthesiologist? It is priceless.

- This is actually a request that is often forgotten, so I really suggest this not only be on your plan, but also verbally stated as your surgery is beginning.

Having double-layer suture repair is often a requirement for future physicians and midwives when discussing Vaginal Birth After Cesarean (VBAC). If you remotely think you might have future children and want to try for a VBAC, make sure your uterus is closed with two rows of sutures.

- By mentioning Baby-Friendly hospitals (and if you don't know what one is, please read about them - start here), you express an understanding that there is another way of recovering from birth (including a cesarean) than removing the baby from his/her mother; you are letting them know you want mother-baby togetherness even if it might be inconvenient for the staff.

There will be the argument that the operating room is very cold, too cold for a naked baby, plus it isn't uncommon for a mom to be sedated post-birth, so holding a baby can be risky.

However, if you tell them, before the surgery, that you would like your healthy baby on your upper chest and breasts and be covered with the warm blankets (they have them in warmers), you will be sure to keep the baby warm and understand the need to do so. It is important to not say, "I want the baby on my stomach" because that isn't possible; you have an open wound there!

You can also tell the anesthesiologist you do not want to be sedated after the baby is born so you can spend time with him or her. You may have to remind him in the OR, too, so please be aware when you are in there. This is very challenging, especially if the cesarean is a surprise. But, keeping your wits about you will afford you many more of your desires than crying and complaining (about the pulling and tugging or the nausea). Know that strange sensations and nausea are common! Tell the anesthesiologist if you are nauseous, but understand they will give you something for it and it will probably sedate you somewhat. If this happens, someone else will have to hold the baby next to you instead of on you. This doesn't mean to just let yourself vomit (on the baby!) to avoid sedation, but that the plans might change if you get medication for nausea.

Many of these things are really great to discuss with your nurse ahead of time. Yes, you will be in labor, concentrating on that aspect. No, you won't want to talk about the "in case of" cesarean, but it really is good on three levels.

1. You will be letting your wishes known.

2. They will have a better understanding of who you are as a patient.

3. They will see you are a reasonable person who will allow the unfolding of your birth, vaginal or cesarean birth.

Number three can transform your labor experience. If the nurse sees you as willing to bend, they tend to bend a lot more, too.

- In most cases, once the baby is born, they are taken from the operating room and dad/partner goes with them to the Nursery. Moms are then left alone, usually sedated and go to the Recovery Room, also alone.

If women ask for a replacement person, usually the doula or grandparent, they will sometimes be permitted to have one. Operating Rooms are run by two people: the circulating nurse and the anesthesiologist. Both of these people will need to give permission to have another person in the OR. If they agree, that means that both support people will have to put the paper scrubs on, the funky hat and the booties. When the nurse comes in to give them to the dad/partner, make sure to let her know... the dad/partner will have to remind the nurse that so-and-so will also be going on after s/he leaves - "Could we have another set of scrubs for them, please?"

- Along these lines is asking that someone remain with you, even in the Recovery Room. By asking for someone "at all times," it encompasses the recovery period, too. It is the ultimate decision of the charge nurse in the Recovery Room, but if you are polite and respectful, they might break the rules if they have one that says "No one in the Recovery Room."

Sometimes, by having someone with you in the RR, you can also negotiate getting the baby to you to nurse. You can let the nurses know your support person will keep the baby safe and close and will hold the baby to the breast so mom can recover. The least amount of medication mom takes at this point, the less sleepy she will be and they will be more inclined to get you together with your baby.

I just had a mom who got out of recovery 30 minutes after her cesarean by moving her legs and then hips - that hospital's requirement for release from the RR. They did not permit her to be with her baby (dad stayed with her) and she wanted to nurse as soon as possible, so was determined to do whatever she needed to do to get together with him. If you want to leave the RR, ask what the requirements are and then do them!

When women have cesareans, because they are often either emergency or unplanned, it can be a time of bafflement and confusion. If you want to adhere to a prepared birth plan, you, the birthing woman, must keep your wits about you. I am not saying you aren't allowed to share your feelings of fear or disappointment, but I encourage you to try and put them aside (for the moment) for the sake of your birth plan/desires. The more calm and in control you are, the more likely you will be able to negotiate your wishes.

I know it seems the doula should be the one in control and to remind you of your wishes - and she can - but ultimately, it is the mother's behavior and words that direct the experience.

This is not a time to be demanding or harsh. (Actually, the more demanding you are in your wishes, the less likely you are to get them.) Be respectful and speak in a kind tone of voice.

(More on attitude and goals further down.)

Baby Care

- Erythromycin is used to help prevent Neonatal Opthalmia (Gonococcal and Chlamydial). Some families choose not to put the eye ointment in the baby's eyes

     1) Because they don't have gonorrhea or chlamydia

     2) They had a cesarean and the only way for the baby to contract neonatal opthalmia is through a vaginal birth

     3) Because they believe if the baby contracts an eye infection it can be treated then

     4) Because they feel it is invasive.

I encourage families to be truthful and honest with themselves when choosing eye ointment or not for their babies. Women have tested negative for gonorrhea and chlamydia, sometimes twice during the pregnancy, and their baby still had the very serious, often blinding, eye infection because their partners gave it to them after the testing period. Research and be able to clearly explain why you do not want the antibiotic in your baby's eyes.

- Vitamin K is used for the treatment and prevention of Hemorrhagic Disease of the Newborn (HDN), a possibly fatal condition that remains extremely controversial in its origin and treatment. I highly encourage you to read as much information as possible regarding HDN before making your decision. Be able to clearly explain why you do not want the injection given to your child.

Families might choose to avoid the Vitamin K:

1) Because there is a great deal of controversy about its usage

2) Because they had delayed cord clamping (which some research seems to demonstrate lowers or eliminates the risk of HDN)

3) Because they believe babies are not meant to have that much Vitamin K in their bodies; if they were, Nature would have given it to them.

Some reasons why a family might choose to administer the Vitamin K include:

1) Because there is bruising at birth (including hematomas, caputs, extreme molding)

2) Because there was an instrumental delivery (vacuum or forceps)

3) Because there was a traumatic birth (including a shoulder dystocia)

4) Because they are going to circumcise their boy or pierce their girl's ears before 8 days postpartum

5) Because the baby is going to the NICU and/or will have procedures that will break the skin and draw blood

Some families choose to give their babies oral Vitamin K. Some hospitals will do this and others will not. Read, ask and learn before you ask your hospital to do this.

- By saying "...at this time...." you are leaving the topic open for discussion and the staff might not be so antagonistic towards not giving your baby the Hepatitis B vaccine while in the hospital. I haven't seen nurses or doctors react strongly when clients refuse/decline the vaccine, but it certainly is possible to come across one.

This is another intervention you must be versed in so you can eloquently defend your decision not to vaccinate. If you are at risk for Hepatitis B, or if anyone that might come in contact with your baby is at risk, strongly consider your choice not to vaccinate. Be honest with yourself!

- Why on earth would the staff have to wear gloves to touch your baby? Because babies are considered "dirty" or "contaminated" if they have not been washed after the birth. They have your vaginal fluids, blood and possibly feces on them. If there was meconium, please strongly consider your choice not to bathe the baby. You, or whomever you designate, are always able to give your baby his/her first bath, whether in the hospital or at home. One major reason for wanting to bathe one's own baby is the ritual aspect of washing. The other major reason is parents tend to be much gentler than the nursing staff. It isn't uncommon for nurses to scrub the babies, especially their heads, with brushes to clean them; parents find this distressing.

Finishing Thoughts

I know this is your birth and you should be able to dictate the way it should go, but you are on the hospital's turf and you are choosing to birth in the hospital, so acknowledging and respecting the keepers of the kingdom (sugar) goes a lot further than defensiveness and anger (vinegar).

If you find your birth plan falling apart because of an unsympathetic nurse (as opposed to an unrealistic birth plan), you might ask to speak to the charge nurse and ask her for a more natural-oriented nurse. Natural-oriented nurses love couples with birth plans (or birth plan-type desires) and go out of their way to help a mom have a great experience.

If your plan is falling apart, even with a sympathetic nurse, you might re-examine what is going on with your birth. Has the normalcy changed? Did you ask for an epidural? (Which would require an IV and continuous monitoring.) Are you vomiting? (I believe you need food in that case, but in the hospital, an IV will be required.) Is your blood pressure going up? Is the baby's heart beat doing funky things? Is there meconium? Has there been no progress in many hours? Are you so tired you can barely see? Have you been whining (as opposed to vocalizing)? Are there people in the room you might wish were gone? Are you "performing" for someone in the room? (This is one of my favorite tricks and I have seen it happen several times, so it bears mentioning.) Has your doula been antagonistic and argumentative? Is your doula trying to direct the path of your birth?

Being honest about why a birth plan is unraveling can help you to re-group and either salvage what can be saved or to re-examine the plan with an objective eye. Of course, this is very challenging while you are in the middle of labor, but having supportive, not medically-antagonistic, support people can mean the difference between a labor and birth that fosters a feeling of success versus an experience that felt out of control and brings with it regret and sadness.

Be sure you even want to have a hospital birth plan. If you choose to create one and discuss it with your doctor/s and nurses, be judicious in what you request.

The goal of a birth plan is to individualize your care, to be seen as a woman with wishes and desires beyond the standard hospital experience. It really is important to remember, however, that you are birthing in a hospital and you will not create a homebirth experience there. If you want a homebirth, have one! If you are birthing in the hospital, know you will be compromising some of your wants while working to keep others; it's the way of hospital birth.  

When you are writing your birth plan, keep it realistic. You and your birth will greatly benefit!

Wednesday
Jul252012

Shifting from Pro-UC to Anti-UC

I was asked how I came to be so against Unassisted (Child)Birth (UC) when I had had a UC for one of my own births. If you’ve read me for awhile, you get the gist of it, but I don’t think I have any one post chronicling the path. Let me see if I can outline it here.

When I had Tristan (in 1982), I had a typical hospital birth with Demerol for pain (epidurals weren’t an option) and a mediolateral episiotomy. At the time, I loved his birth! I loved it so much I wrote letters to the doctor, nurses and hospital President thanking them for such an awesome experience. I didn’t know any better.

Then we moved to Tacoma, Washington and, pregnant with Meghann, I found a Bradley instructor who was also a La Leche League leader and prenatal exercise teacher… Marie Foxton. She was amazing! I glommed onto everything she said, reading anything she offered voraciously. Included in the reading material were newsletters (The New Nativity) from Marilyn Moran, the American mother of UCs. Birth and the Dialogue of Love was Marilyn’s book about husband and wife birthing. Her spin on UCs was that only husbands should be with the woman, no doulas, no friends, no kids; just the man you made the baby with. (Even UCs can have fringe elements!) The idea resonated with me perfectly and I set out to have a, what was called then, Do It Yourself (DiTY) birth. I was supposed to have my baby at the military hospital at Ft. Lewis (Madigan) and continued with prenatal care there. Standing between sheeple and birth anarchist, I had my membranes stripped without my permission (unless taking my pants off designated consent) and contracted for many hours before active labor really kicked in. Not one to just hang out with one man, I’d invited several people to the birth, too. One, Marie’s daughter who took pictures of the event (you can see them here in Meghann’s UC Birth Story) and the other two friends from LLL and my exercise class. Both women had newer babies they brought to the birth as well.

Over the years, I’ve had judgment saying I didn’t really have a UC because there were other people there. That they influenced me and didn’t allow me to listen to my own instincts, which, by the way, would have led me to the hospital. But it was a UC; there was no medical/midwifery provider there. No one listened to fetal heart tones. No vaginal exams. No blood pressure taken. No thought about the baby’s journey, just my own. When I hear UCers talk about their reasons for wanting to have that type of birth, it is rare that anyone even mentions the baby, especially the safety of the baby. They might say they don’t want the baby poked and prodded or they don’t want the baby taken away from them, but those aren’t safety concerns; they’re inconveniences. No one says, “I’m doing this because I don’t want anyone there because I don’t want any neonatal resuscitation or medications for hemorrhage." They honestly don’t believe they will need such things or they will have time to get help if they need it. They are wrong.

Reading Meghann’s birth story, you can see that she was a shoulder dystocia and nearly died. Had I had a midwife there, we wouldn’t have had to call EMS and the transition after birth would have been much more fluid and gentle. Even still, I thought the birth was awesome for many years.

This is where the question comes in: What changed my mind?

Time, distance and experience. When I saw a mother die in 1987, that was a huge sobering experience that profoundly affected my understanding of mortality in birth, both maternal and neonatal. After that, I knew it would be many more years before I was ready to be a midwife. In fact, when I was finally licensed in 2005, my reason for not becoming licensed sooner (despite being in birth work since 1983) was that I had not been spiritually or emotionally mature enough to take two lives in my hands. I wonder if we ever really are.

When I had my UC, I thought I was extremely knowledgeable, having read so many natural birthing books including Spiritual Midwifery and Oxhorn-Foote’s Human Labor & Birth. I studied the second half of Spiritual Midwifery (the technical parts) more than I read the first half with stories. I really did think I knew a lot. But, through the years as a doula, then attending Casa de Nacimiento in 1993, it slowly dawned on me how little I really knew. While I was still very much of the belief that women needed to be protected by their doulas and partners and that technology was mostly out-of-place, I saw experiences in the hospital and birth center that technology never caused. It was clear that sometimes, shit just happened in birth, even when it was left alone… sometimes, because it was left alone.

In 2003 (or so), I started writing an updated Emergency Childbirth for UCers, a manual that talked about what to do with emergencies when alone, whether accidently or on purpose. I wanted to market it to those who might get stuck at home in snowstorms or for after an earthquake and submitted chapters, but no one bit.

In 2005, I helped put on a conference with the California Association of Midwives, International Cesarean Awareness Network and Birth Resource Network and became a speaker for a workshop on UCs. (I can’t remember the name I gave it, sorry.) I loved the workshop and really felt I gave great information about how to overcome emergencies during an Unassisted Birth. I talked about shoulder dystocia, hemorrhage and surprise breech among other less emergent issues. I talked about what to do with tears and how to get a birth certificate as well. After the presentation, I was talking with the participants and one very pregnant woman came up to me and said she was going to UC, but wanted to know if she needed anything, could she call me… like for suturing. Absolutely! I would be more than glad to offer whatever I can, even if it’s just phone help. She thanked me and then we moved on with the rest of the conference.

A few months later, there was a buzz in the community about a UC death, the baby died during a shoulder dystocia. Immediately, I thought about the woman at the conference and wondered if it was her. It was. A few months after hearing about the birth/death, the woman contacted me and we began a several week processing of her experience. (I have permission to talk about this.) This mom was as connected to her body and fearless as anyone I’d ever met; it was stunning she lost her 8-pound baby during a shoulder dystocia. While we talked, she off-handedly said, “Barbara, I did everything you said to do, but my baby still died.” And it was in that second that I realized what I said and did as a midwife could make the difference between life and death… even if I wasn’t at the birth. She meant nothing unkind, no blaming or anything, but I took what she said and beat myself up for years, worried I’d done or said something that encouraged her to go through with the UC. I know intellectually that she made her own decision and that she was going to UC no matter if we’d ever met or not, but maybe what I said bolstered her belief that she could handle any complication. I now feel I gave completely false hope that complications could be handled alone, without medical or midwifery assistance. My heart still aches about the lost baby.

Other parts about that birth come into play, too, because the hospital didn’t treat the death with all the gentleness they should have. Mom never got a photo of her baby, no lock of hair, no blanket… nothing. She can’t remember what he looked like when he was born because they didn’t respect the protocol of what to do when a baby dies. We’ll never know if she was punished because of the UC, but I still cry that she never got a picture of her precious son.

So, after this experience, I did a 180° change.

Shortly after, a dear Netfriend also lost her baby during a UC, a cord prolapse in second stage that was mismanaged by the 911 operator. Had a midwife been there, the baby would, almost certainly, have been alive.

I got my midwifery license in 2005 and worked hard to be a midwife for as many on the fringe as possible. I met a woman at an ICAN meeting who was going to UC and I begged her to please let me attend. A horrific shoulder dystocia of an 11+ pound VBAC baby and subsequent hemorrhage shook all of us up so much, my anti-UC stance was solidified. Every one of us, including the mother, knows if we’d have not been there, both mother and baby would probably not be here. Shook me to the core; I still have nightmares about that birth.

Earlier, before the conference, I’d become Netfriends with Janet Fraser. I was incredibly distressed to learn she lost her baby during her UC. I was also angry as hell. I wrote a piece called “An Open Letter to Janet Fraser” that was harsh and extremely angry. A few years later, I removed it and apologized for the crudeness of my words. I still feel angry that she lost a baby that didn’t need to die because of dogma.

So, there you have it; my transformation from pro-UC to anti-UC. Believe me, I understand that some women have limited to no choices about some aspects of their births, whether they are VBACs or breeches or twins or midwifery isn’t legal or there are no midwives in the area, but I feel so strongly that women should have an attendant that if there is no way to have a midwife (or doctor) at the home for the birth, they need to be in the hospital. I know that seems mean, but it’s far worse to offer condolences because of a dead baby.