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Monday
Apr302012

Cesarean Scar: Mandy Renfro

 

My c-section scar hurts. It itches, sweats in the hot summer months, and is numb. It even feels this weird, uncomfortable, pressure feeling when anything, even my husband’s loving caresses touch it.  The weird feelings aren’t limited to the scar itself, but the area below as well.

My stomach has this flap- pooch thing that will never go away.  It is a horrifying lump that rears its ugliness when I wear stretchy pants, some skirts, and a swimsuit. I fear I will always have to wear a girdle of sorts to smooth everything out.  I don’t like my husband to look at my body, I can’t even shave there completely.

My scar says a lot of things to me when I look at it.  It reminds me that my doctors didn’t even give me an option of a VBAC the second time.  It reminds me that I didn’t get to see my oldest son until he was 2 hours old, and that I didn’t get to see my second one until I threw a fit; I didn’t get to see him until he was hours old, I only got to see him those 15 minutes.  It reminds me how I wasn’t allowed out of bed for 24 hours.  My youngest son was in the NICU, and I didn’t get to hold my baby and kiss him until 28 hours after his birth.  And even then, I was in so much pain. It HURT me, both times, to cuddle my sons, to be their momma.  I kissed their foreheads through tears of pain.

Both times, my incision became infected and would not close.  Thus, putting me through weeks more of pain, doctor’s visits, and medications.  The scar says to me, when I look at it … “you wouldn’t have me if you tried harder the first time, you didn’t fight hard enough for your second birth.”  It reminds me that I never got to FEEL my sons come into this world. I did not witness them physically entering the world.  I didn’t get to see their naked, new bodies.  I met both of my sons when they were wrapped in blankets with knit caps on.

When I touch it, it says “that feels weird”. But also, some different feeling comes over me. Connection. This … thing on my body, thick and bumpy, itchy and numb… will always be with me.  The way the most beautiful people came into my life, was through it.  When they’re grown and gone with families of their own, I will still have my scar.  The sense of touch triggers such an emotional response from me.

I can lose the extra pounds from pregnancy and I don’t have many stretch marks, but my body will always, ALWAYS have a reminder of my pregnancies with my boys.

It isn’t the prettiest, most comfortable thing, but it is important, a part of my history, a part of me, a part of them, a part of us.

Monday
Apr302012

Cesarean Scar: Anonymous (2)

I have no photos. 

I have a completely undetectable invisible scar on my skin from my July 7, 1986 unnecessary cesarean section.

As Dr. Dena Harris hand sewed the stitches, she remarked "I love sewing".

I thought it was funny at the time, but it dawned on me later that Ob's are always a surgeon first.  
 
Impatience should have disqualified her from practicing Obstetrics.

Monday
Apr302012

Cesarean Scar: Anonymous

My scar is far less visible than my natural stretchmarks.  It doesn't say much when I look at it.  It doesn't hide, it doesn't hurt.  It doesn't sadden me, or make me smile. It is there and accepted neutrally.

My scar feels hard and tight to touch, with soft squishy cushions of belly on either side.

My external visible scar means almost nothing to me, it is numb.  My emotional scar, strangely detached from the physical, rages like fire, hurts, saddens, weighs heavily... hides occasionally, but continues to reappear when touched.

Monday
Apr302012

Cesarean Scar: TM

I have delivered once vaginally and twice by C-Section.

My son was over 9 pounds and although head down was stuck in the birth canal. I had a choice to make during this time when his heart rate was slowing and I was panicking, forceps or c-section? Being terrified of surgery because I had never had it, I opted for forceps. They pulled my baby out and traumatized my vagina for a really long time. I don't mean to sound depressed because I'm not. Our son was healthy and suffered only a slight bruise on his head that faded in a day or two. My body would not heal though-it was like 3 months of hell for my vagina.

I decided for my second and third deliveries that c-section was the only option for my body and the health of my babies.

As I look at the scar, I don't love it but I don't loathe it or hate my life because of it. It's kind of discolored and there's an irregular tuck and bubble right above it that I try to maintain with diet and exercise. I keep it in perspective though. It was the passage-way to life for my two lovely daughters. Thank God for that. I wonder if it weren't for modern medicine if I would have died in my first delivery or if my son wouldn't have made it, then where would my girls be?

I love that it's there because it means my girls are here.

Monday
Apr302012

Cesarean Scar: Paige's Birth Stories

Nora

I went in on a Friday to see my midwife. I was a little more than a week overdue at that point so they strapped me to the monitor to check things. Everything looked fine except the baby wasn't moving as much as they wanted. My midwife said just to be safe to go to the hospital for a NST. She told me that if I wanted to, just tell them I'm ready to have the baby and they'd induce me. That should have been my first clue that things might not go the way I was hoping.

So I went to the hospital and they decided that I was low on fluid. Fortunately the midwife on-call at the hospital was really understanding about me NOT WANTING an induction. Despite the doctor's recommendation (and my mother, and my aunt, and my grandmother) that I induce, the midwife suggested I go home over the weekend, drink tons of water and come back for another NST on Monday. I was very relieved to have another option.

I showed up at the hospital Monday afternoon and had another NST. While my fluid had not gone down, it hadn't come up either so the doctor, midwife, nurses, and my entire family told me to just get the induction. I still felt like it was the wrong thing to do, but everyone else was telling me to do what the doctor said and they kept insinuating that by NOT doing that I was endangering my baby's life. So I agreed.

You have to be 4cm to start pitocin and I was nowhere close (about 1 cm) so they used a Foley bulb to dilate me further. It was painful, uncomfortable, and invasive. They basically insert a balloon inside your cervix, inflate it to 4 cm, and it puts pressure on your cervix. When your cervix dilates to 4cm it falls out. The thing is connected to a tube that runs down your leg, which is taped there to hold it in place. They did this later in the evening and told me to sleep with it in. Yeah. Right.

By this time everyone had gone home because it was clear I wouldn't be in labor any time soon. There was no bed for my husband to sleep in so he asked if he could go home too. I wanted to say no because I was so scared to be there by myself, but I knew that if I did go into labor the next day I'd need  him to be well-rested so I said that if he wanted to go he could and he did. I've never been so lonely and scared in my entire life and I just lay there crying for a while. I felt abandoned and then guilty for begrudging him sleep. To my surprise, I actually fell asleep.

I woke up a couple of hours later and had to pee so I went to the bathroom. While I was there the bulb fell out of me. There was a lot of blood and it was sort of frightening. I called the nurse and she just told me over the intercom to leave it in the bathroom. I was disappointed she didn't come in because I was still feeling lonely and wanted to actually talk to someone. I fell back to sleep, much more comfortable now that I didn't have a contraption inside me.

The next day my family showed back up cheerful and well-rested. I was feeling a bit grumpy myself, but tried to be excited that I was going to have a baby today. I thought. I asked the midwife if I could go walk around outside for a while before they strapped me to all the IVs and monitors because at that point I'd been in that hospital room for almost 24 hours. So I got my last breath of fresh air for a while and walked around outside the hospital. It was a beautiful fall day.

I went back in feeling much better and settled in for a long wait. They started the pitocin and an IV antibiotic. The first anesthesiologist came in and offered me an epidural. That pissed me off because it specifically said in my birth plan NOT to offer me medications. I wasn't even in labor yet for crying out loud! It would have been waaaaay too soon for an epi even if I'd wanted one. I just said, "No. I'm not using medications." He laughed and said, "I bet I'll see you later" and walked out the door. I was pretty pissed off, but my mom and husband said "oh he was just kidding, you're making too big a deal out of it" so I tried to let it go.

After that it's a long, boring blur. Every few hours or so a new anesthesiologist would come in and ask if I was ready for an epi yet. I got irritated…then I thought it was funny, especially since I still showed no signs of labor. They kept cranking up the pitocin, but nothing was happening. I dilated to about 6cm by early evening, the monitor showed regular contractions, but I felt nothing. The baby was perfectly happy and showed zero signs of distress. I laid there on my back and got up from the bed only to go use the bathroom. I started lying about needing to pee just so I could get up.

Sometime in the evening a nurse offered me a rocking chair. I was surprised. I asked if it was ok for me to get out of the bed and she said of course. Geez, I wish someone had told me that earlier!! I'd have been up moving around, squatting, rocking, kneeling on all fours, all the things I knew would help the baby move down. At that point I don't think I sat down again. I stayed on my feet except when they checked me for dilation.

I don't know what time it was when the midwives changed shift, maybe 8ish, but the new MW came in and it seemed like right away she decided she needed to know how strong my contractions were since I hadn't dilated past 6. She put an internal monitor on my cervix, which meant the end of my standing. I had to lay on my back and try not to move at all. It wasn't long before I felt the water trickling out. I let her know my water had broken and she removed the monitor. I’ve since learned that the water always breaks when they use an internal monitor, but the midwife didn’t tell me that part when she said she was going to put it in.

At any rate I got excited once my water broke because suddenly I could actually feel the contractions. I thought what I'd been waiting for for two days was finally happening- I was in labor!! I was thrilled.

Then the midwife came back. She said the monitor showed that I was having really strong contractions and that because I wasn't dilating despite the contractions she thought it was time to do a c-section. I felt like someone punched me in the stomach and knocked the wind out of me. I started crying and said, "but I can feel the contractions now, I'm in labor." She told me I'd been in labor for a while and it wasn't progressing anything. I asked her if we could please just wait a little while to see if anything happened and she said she would give me one hour. If I hadn't dilated by then I had to have a c-section.

She put me in the "Pretzel" position, which apparently is supposed to encourage dilation (again, no one could have suggested that earlier??) but unfortunately makes the fetal monitor hard to keep in place. I spent the entire hour crying to myself, listening to my mother and husband tell me it was for the best, and trying to ignore the nurse who would not leave me alone and kept messing with the stupid monitor. I wanted to scream at her that surely after 13 hours of lying there with the damned monitor strapped to me and the baby had never once shown any signs of distress, surely it would be ok for the next hour. But of course I didn't. I just kept trying to help her get the monitor situated. She didn't try to hide her frustration and impatience with me at all. She clearly thought I should just go do the surgery and get it over with.

Then the MW came and checked my cervix again. Still 6 cm, so she said. I have my doubts about whether she would have actually told me if I had dilated, but maybe I'm just paranoid.

So that obnoxious nurse came in, much more cheerful now, and shaved the top few inches of my pubic hair. Someone came in and gave me a shot of something "to calm me down." I requested they wait to give me a catheter until after I'd been numbed and they said yes. It was the best decision I made all day, I think, but the nurse seemed to think it was weird.

They rolled me to the OR, which looked like a supply closet. They said my husband would join me in a minute. The anesthesiologist just happened to be the same one who'd been there 12 hours earlier. He said, "I told you I'd see you later." All I can say is that it was a good thing that they gave me that shot to calm me down because I remember being angry but just not caring. That stupid nurse who'd been badgering me for the last hour was there as well. While they are getting things ready they were gossiping about some guy who was "totally looking at" one of the nurses. I didn't understand how they could not realize that I was laying there having one of the worst moments of my life. I wanted to scream at them that I knew they probably did this everyday, but I didn't and it was really scary and emotional for me, but I just didn’t have the energy. Probably because of the shot they’d given me.

My husband still hadn't shown up, but it was time for my spinal block. The thing I'd feared most throughout pregnancy- the reason I never wanted an epidural- a needle in my spine. I thanked the shot again. I leaned on the MW. Suddenly I thought someone had splattered boiling water down my left leg. I jumped and looked to see who'd dropped a cup but the MW just told me not to move. It was just the needle hitting a nerve. I laid back and they raised the curtain. I zoned out. The part of my brain not "calmed" by the shot wondered where my husband was.

Finally he came in. He seemed surprised they'd already started. Apparently he'd gone to get a cup of coffee and they couldn't find him.

It's all a blur from there until at 1 am I heard the doctor say, "Oh, what a beautiful baby." I remember wondering whether he said that about all the babies. I tried to look and see but the curtain was in the way. By the time they brought her to us she was clean and swaddled and had a little cap on, but she was the most beautiful thing I'd ever seen. Her face was so pink and her eyes were closed and she looked so peaceful. They handed her to my husband and I reached up and touched her cheek and said hello. I laid there with my hand on her cheek for god knows how long. It seemed like ages.

I started to realize that I felt a vague burning sensation in my abdomen. I told the anesthesiologist that I felt something. He asked me what it felt like and I thought for a second and said, "it feels like fingers in my belly." He said, "Let's get you a shot of morphine." They don't tell you this, but morphine makes you itch. It was terrible, it started in my nose, then my face...neck...chest. I was trying to focus on the baby but I was so itchy and I'd been laying there for so long.

Finally they finished and I was able to hold my baby for the first time as they rolled me back to my room. For a few moments all was right with the world. It wasn't so bad. My baby was healthy and I was OK. As soon as they parked my bed I put my daughter to my breast and she latched right on. I was so happy. I slept with her all night in my bed with me, nursing and snuggling.

The next day I was in the bathroom when I heard my usual midwife come in my room. It was the first time I'd seen her since that Friday she'd sent me for the NST. I sat there in the bathroom afraid to come out and started crying. I couldn't face her. The last time I'd seen her I was pregnant and happy and confident and now I'd failed. She was going to be disappointed in me and I was scared to look her in the eye. I tried to clean off my face and look like I wasn't crying and walked out to see her. That was the first time I pretended like it didn't matter but it wasn't the last.

Davis

Despite all my gentle attempts to naturally induce myself I had not gone into labor. I had to really fight with my midwives’ overseeing OB to get to 42 weeks, especially after I agreed to the US to check the baby's size and they estimated him at +9lbs. They scheduled a c-section for the day I hit 42 weeks. That was a Sunday. Here's the rest of the story...

Saturday morning at 6am I woke up and felt my first real contraction. It felt nothing like anything I'd felt before so I thought it was the real thing, but was afraid to get my hopes up again. They continued regularly every five minutes for over an hour so I knew something was really happening. I took a shower and they started coming one on top of the other so I called my doula. While she was on her way they evened back out a bit. My mom came and got my daughter and I settled in to what I thought would be a pretty quick labor- since they were already so close together and lasting about 45 seconds. Over the next few hours they got to every 2 minutes and stayed there. All. day. long. I should have tried to do other things to take my mind off of labor, but I was so afraid that if I stopped concentrating on the contractions they'd stop coming and I'd end up on that OR table the next day.

Around 6:30PM that night I called the on-call midwife because my doula was afraid I was going to get too worn out and she wanted me to try to speed things up. I'm so glad I called the midwife because she assured me that the surgery was definitely off since I was in labor. I didn't realize I'd been worrying about that all day- like I was trying to labor on a time clock. She told me to relax, make myself comfy, take a warm bath and let labor take its own course without trying to speed things up. I felt so much better. I sent my doula home- that was actually a big relief. She was starting to stress me with suggestions of how to speed things up and I was tired of being stared at.

So I took a hot bath, relaxed, laid down in bed, tried to watch SNL and dozed between contractions for a while. After a few more hours the contractions weren't getting closer together but they were getting harder to deal with and more intense so I decided to head to the hospital. I'd been in labor about 18 hours at that point, though I lied to the midwife when I got there and said the contractions had started early afternoon sometime. I really didn't want to be on their clock.

The drive to the hospital sucked, but we got there Sunday morning at 1am. We got lost trying to get in to the maternity ward but a friendly security guard helped us out and let us in the door that was locked after hours. The nurses recognized my name from the surgery roll for the next morning and were really excited for me that I was in labor. I was 5 cm when I checked in and incredibly happy to hear it. I had a heplock for antibiotics (I was GBS+) and was on continuous monitoring because I was VBAC, but generally comfortable and able to move around. I decided not to worry about whether they were getting good monitor readings and that made things easier. I used my yoga ball to sit on, lean on, drape myself over. I squatted into contractions, I laid on my side for a while. Basically I tried every position in the book and just generally stayed mobile.

By 4am I was 8 cm and 100% effaced. I heard that and cried with happiness. Then my body decided that it was done for a little while and I stopped progressing. It was probably good because I was able to sleep a little bit, but after a few hours they started talking about internal monitors and pitocin so my body kicked back into gear. In another hour or so I got to 10cm with a cervical lip that just wouldn't go away. I was getting frustrated at that point because I felt like no one was telling me what to do to make it progress. The doula was useless at this point (I’m sure she was worn out) and I was getting so tired and just frustrated. The pain really wasn't much of an issue for me, I was just exhausted from lack of sleep and a long labor and just READY FOR THE BABY TO COME OUT.

Then shifts changed and this angel of a nurse came in and started quietly making suggestions in my ear about how to stand, where to put my feet, how to curl my back forward instead of backward during contractions to get the baby around my pelvis. I got to the point where they said I could try pushing past the lip but the baby kept slipping back. The midwife (the same one I had talked to the night before on the phone) assured me that at this point I WAS going to have a vaginal birth, but they thought a "whiff of pit" would strengthen my contractions and make them consistent enough to actually push the baby out. I was still falling asleep between them at this point. I didn't even notice the pitocin, but once they gave it to me it took about 45 minutes of pushing before the head came out (at 11:13am after 29 hours of labor). I was laboring on my back at this point holding my feet and pushing against my own hands with some help from my aunt on one side and the nurse on the other with my mom holding my head and helping me curl into a shrimp position. My husband was waiting to catch the baby and my sister was watching over his shoulder. My eyes were mostly closed but I have a few mental images of seeing their faces as the baby was coming out. I thought it would be embarrassing but it was encouraging because they both looked so amazed and impressed. Then the head popped out and everyone cheered.

The amniotic sac was still intact and she had to burst it by poking her finger in his mouth. Then they told me to stop pushing because his shoulders were stuck. My husband was not able to deliver him because the midwife had to maneuver him a bit, which caused a tear, but when I felt his body slither out everyone in the room cheered.  They put him up on my belly and I reached down and felt that he was a boy. He was just as beautiful all messy and blue as my daughter had been clean and pink. They had to take him away after a moment because he was in a little bit of shock from getting stuck, but they assured me that he was just fine and they kept him in the room while they checked him over. I delivered the placenta (that thing was huge!!!) and then they stitched me up. The stitching was the first time I said the word "epidural" the whole time I was in labor. That was the worst part of the whole experience. I tried to hold the baby to distract myself, but I was yelling so loud I had to give him to my husband until they were done. It took forever, but they finally finished and gave my baby back to me. I offered him my nipple and he immediately latched on and went to town like he'd been doing it forever. It was wonderful. It was the most healing, amazing experience of my life and I hope every woman can experience something like it.

Monday
Apr302012

Cesarean Scar: Paige

If you'd asked me what my scar said to me when I looked at it or touched it a few years ago, I'd have said it was mocking me. It said, "Look what you let happen. Look what you let them do to you. Look how weak you are." It was a constant physical reminder that I failed at birth. I knew intellectually that I didn't fail, that it was the broken system that failed me, but emotionally I felt like a failure. I didn't mind the stretch marks or the varicose veins as visible proof of my motherhood, but that scar was a different story. I'd loved being pregnant, every second of it. And even though I went well past my due date I never felt "done" with being pregnant like so many moms do. But the medical professionals felt differently and even though looking back I can say that I did everything reasonable to avoid it, I still felt guilt for giving in to the fear and agreeing to an induction that I KNEW would not work. I KNEW my baby wasn't ready to come out yet.

As c-sections go, mine was actually not that bad. I was not separated from my daughter and I was able to nurse her within about an hour of her being delivered. She was perfectly healthy and my recovery, while difficult, was nothing out of the ordinary. But emotionally I had no idea the kind of fallout I would face. I couldn't acknowledge the shame and guilt. I hid in the bathroom of my hospital room and cried when my midwife came to visit and I didn't even know why until much later. It wasn't until I started talking to other moms who'd had similar experiences that I realized it was normal, or at least very common. Most of the people around me didn't understand and my inability to be happy with my experience made them noticeably uncomfortable. But once I was able to talk about it with people who didn't just reply, "your baby is healthy and that is what is really important" I started processing those mixed up feelings and even started to heal a little bit at a time.

The anger came first. Anger at the medical community, anger with myself, anger at all the people who had been present at the birth. Then came the acceptance of what happened along with a determination not to let it happen again. When I got pregnant with my second child the fear reared its head again, but I faced it head on this time and really examined what I was afraid of, how I could avoid it, and made lots of "what if" plans. I fought like a mama bear through most of my pregnancy to make sure the birth would go the way I wanted it to go and finally I had to just give up my false impression of control and trust my body to do what it was made to do. And it did. And it was the most healing experience of my life.

So now my scar says something different. It says, "Look what you can do! Look what you can overcome. Look how strong you can be." I may not be a the point yet where I can say I'm proud of my scar, but I don't avoid looking at it in the mirror anymore. I don't avoid washing it so I won't have to feel it, in fact I can barely feel it at all unless I really try. It's beginning to fade into my skin the way the memory of the birth is fading into the past, becoming a small part of my life experience. That doesn't mean I'll forget and it doesn't mean it's not important, but it doesn't have the rawness of a fresh wound anymore. 

Monday
Apr302012

Cesarean Scar: RL

I dont have a photo of my ceasar scar but would love to share my story.

Ceasar scar number one was an unplanned ceasearian. My little baby boy was breech. I was very scared about the whole thing and was dreading through the whole pregnancy not to have to have a ceasarian but these things happen. As long as he was in my arms healthy and safe that's all that mattered to me.

Ceasar scar number two was also not planned but I was told I couldn't have a natural birth after a ceasar, which now I know is not true but like the first birth as long as he was in my arms healthy and safe which he was.

Ceasar scar number three- I went into natural labour and was all ready for a natural birth but the doctors advised against it as things were moving too fast and could rupture the previous scars. So again I went along with the ceasar and had a beautiful little girl.

Although I never wanted a ceasarian with any of my children, I love my scar. My babies were born out of that scar. It reminds my everyday of my beautiful children and I wouldn't change a thing. My scar isn't ugly to me. Yes there is that flap of skin that no matter what amount of exercise you do you can not get rid of it. But if that's all I have to live with then that suits me just fine.

Monday
Apr302012

Cesarean Scar: Samantha Venn

My scar is not a source of pain. I don't think it's ugly, it's practically invisible. When I touch it I can barely feel it. I will share my scar's story, and the story of how I've come to love my scar for what it means to me.
 
My scar came after 23 hours of labor, 2 hours of pushing, and when the exhaustion took over my body a doctor looked into my vagina where we could see my sweet boy's head and said it was too high for forceps. I was taken to the OR. When the doctors found I was numb enough to cut they made an opening in my body to bring my son into the world. After they sewed my insides shut they stapled the outside closed. At this point my scar was untouchable to me, I couldn't bear the thought of seeing it because it was my failure. It oozed with pain and emotional baggage from my son's birth. Not only did I hate my scar, I hated myself.
 
When I was finally brave enough to confront the monstrosity carved into my body I was horrified. My body was mutilated, my baby was cut out of me, I was a mother that never gave birth. I was angry, but my scar was obviously healing.
 
Over the months my scar faded and I began my true healing journey. Talking and writing about the trauma that brought me and my scar together, doing art to understand my scar, to understand what happened. Learning all along that my scar wasn't necessary, that my body did not need to be cut. While the cut that created my scar caused emotional scars, my scar was proof that I would heal inside and out.
 
It's been over 4 years and so much has changed. My scar says so much to me and about me. I no longer hate my scar, when I feel it I touch it gently with only love and acceptance for what my body and soul has survived. My scar has held strong through 2 more pregnancies and held strong while I birthed two more sons vaginally without medication and without interference. I thank the women before me that found the beauty in their scars and shared their joy and wisdom from this revelation. I see my scar for what it is to me, proof I will do anything for my children and that I can survive anything because of my children.

Monday
Apr302012

Cesarean Scar: Shannon Tells M's Birth Story

You are, right now, cuddling with your Nana.  You were born 12 days ago, on August 7, 2009.  I have just fed you and we played “see the baby” in the mirror and then “look at mommy” and then you started fighting taking a nap.  You did this yesterday too, at about the same time.  You are so enthralled with what there is to see in the world that you are loath to shut your eyes!  You eat everything you see up with these big inquisitive blue eyes�I wish I knew what you were thinking.

On Tuesday, August 4, I went into early labor with you.  I woke up around midnight or one in the morning with contractions that started out every 20 minutes apart and then gradually got further and further apart.  When I woke up that morning, around 6am, I was bleeding.  I called Diana H., our doula, immediately and she assured me that I was losing my mucus plug and that everything was okay.  I thought it was false labor; hindsight, however, brings clarity. I also had a prenatal appointment that day with O.L., one of the midwives.  She was concerned I was already 4 days post-due and wanted to schedule a prostaglandin application for Thursday night.  We scheduled it for 7pm on Thursday, August 6, to encourage you to arrive.  

I continued to get contractions through the following day, Wednesday, August 5, but nothing that established itself.  By the morning of August 5, I had lost the mucus plus entirely, but the contractions continued to be sporadic at best.  I coped with them by rocking back and forth or by hanging on to the kitchen counters.  I also hummed a lot through them.

Early Thursday morning, August 6, the contractions settled into a pattern that kept getting closer and closer together.  I thought I was going to have you that day, since it was a full moon.  Your daddy said good-bye to me that morning and I remember we talked about what to do if the contractions got closer together throughout the day.  He was in charge of a big project at work that was releasing that night and had to make plans for someone else to cover it if need be.  I read books that day and watched a movie.  I even went down to the pool for a little while (I spent a portion of every day the last 4 weeks I was pregnant with you in the pool; you liked that a lot and almost always gave me a few pushes or rib kicks while I floated around).  I went to the chiropractor that day around 4pm convinced I was in real early labor; my contractions were about 15 minutes apart, but labor slowed down durring and after my visit.  I suppose that just proves the adage that a “thinking” woman cannot labor.  Diana had always told us you had to turn off the thinking part of your brain and go with the intuitive part of your brain to birth a baby; I remember thinking about her comment after I got home and the contractions spaced out to 30 minutes.  I called Diana again and checked in with O.  O told me to take a warm bath. 

I drew the bath water and called your Nana so that I would stay awake.  I was so tired because the contractions had kept me up most of the night before and I hadn’t been able to nap the way O and Diana suggested all day because of the contractions.  The bath must have done it, after that, the contracttions started getting closer and closer together.  I called your dad and told him to wrap up and get home.  I called O.  I called Diana.  I lay on the bed upstairs, but I couldn’t sleep.  Every time a contraction hit, I had to get up and walk around.  Lexi followed me, as she had been doing, even sleeping in the bed next to me (or trying to).  I started tracking the contractions around 6:30pm that night.  They were about 8-10 minutes apart.

Your daddy got home around 7:30pm.  We called O, she told me to get Diana to our house and that she had cancelled the prostaglandin appointment for us.  She listened to one of my contractions and talked me through it.  At the end she said “now take a deep breath, just like that”.  Just like that was her refrain.  I found it so comforting.  I labored probably another 30 minutes before we called Diana.  I wasn’t sure if she should come, but I guess she heard me and hung up and headed over.  I got into the shower for a little while; the warm water felt so good!

At this point, things get very, very fuzzy for me.  I know that Avery was there; he put on music and danced with me through contractions.  I would sit on the couch in between them, with Lexi at my feet and Avery either sitting next to me or gathering things to go to the hospital.  Then, a contraction would roll up on me and I would motion him over.  He was come and we would dance through the wave.  Then, I would sit back down or walk back and forth in the living room.  I wasn’t sure how long it went on.  Sometimes Diana would come and help me, or she would offer suggestions or something to drink.  Finally, she said we had to go because contractions were 2 minutes apart and the baby was coming.  I remember Lexi wouldn’t crate up and I had to do that, but she and Avery did everything else.  I was very happy when she let me keep the TENS machine, which I had been using to cope with the contractions, on in the car.

In the car, I was surprised to see that it was past midnight.  I had been laboring actively for well over 4 hours, probably almost 5 when we got in the car.  Avery drove like a controlled mad-man to the hospital, calling your grandparents (both sets!) on the way.  I  kept asking him if he’d called and he kept telling me to focus, putting him hand on my leg through my contractions.  Being confined in the car and unable to move and dance made the contractions more painful and harder to cope with, but somehow we pulled up to the hospital in about 15 minutes.   (Considering it’s a 25 or 30 minute trip at best, I can only imagine how fast he went!)  We parked in the emergency red zone and Avery helped me make my way as quickly as possible to the entrance.  I guess he’d called the night nurses before we arrived because they seemed to expect us.   I remember the nurse who answered the call box was named Shannon as well and Diana laughed about it.  I had two or three contractions on the way down to the nurses’ station and Diana, Avery, and I danced our way through them. 

Checking in is a big blur.  O was there pretty quickly and the nurse kept asking question after question.  They wanted to monitor you and me for 20 minutes and then told me I could walk around.  O checked me and I was completely effaced and 4 cm dilated.  I think it was longer than that, but time, at this point, was irrelevant.  The contractions kept rolling over me, oceanic waves, rolling, rolling, rolling.  Avery or Diana or O would dance me through them.  Finally, they got me on a telemetary fetal monitor so I could walk.  I was walking and pacing through the contractions.  Then, I was sitting on the birthing ball, rocking back and forth, which felt good.  O felt like we’d have a baby soon.  But soon, when was that going to happen?  At some point, they came in and we had to move down the hall to a new room.  Apparently, I was being too loud and the mom next door to me was on seizure watch.  So, we walked down to the new room at the end of the hall.

I think at this point, O or Diana suggested I get in the tub.  Oh, it felt so lovely!  Diana kept the shower head on, running it up and down my belly and legs in the water.  I think Avery was sleeping at this point.  He, too, had been up over 24 hours at this point because he had not slept the night before when I kept having contractions.  I was in the tub a long time and this nurse kept coming in to check my blood pressure.  At one point, they even had me talk to a doctor.  A doctor, not O!  He tried to get me to get on narcotics because he said my bp was too high.  I had been told it was 150/100 and I almost let him convince me, but Diana said it would interrupt the endorphins and I didn’t have to if I didn’t want to.  I called for O to come down and do a consult (she’d been up much longer than I had, having been delivering babies like crazy the whole week!  She’d gone to another room to try and get some sleep).  She came back and stayed at that point, I remember her saying that if it took her being next to me to keep my bp down, then that’s what she’d do.  I was so thankful. I didn’t like the nurse on the morning shift who kept taking my bp during contractions and who kept bothering me.

I don’t know what time of morning it was, but it was after the day nurse, Marie, came on duty that O checked me again.  Barely 6 cm dilated after several hours at the hospital.  O was worried because I was getting tired and my contractions were starting to get further apart.   She also said that the scar tissue on my cervix was holding things up and I should get pitocin.  She left and I talked to Diana.  Diana told me she’d seen O break up scar tissue before, so that’s what O did, she broke up the rest of the scar tissue and it hurt like fire!   She also finally convinced me to get pitocin to increase the strength of the contractions and get your head down on to my cervix, you were still so far up in my pelvis!  I finally relented and they hooked me up to the IV.  At that point, I remember the contractions getting harder and closer together.  I also remember that everyone cleared out but Avery and Diana.  I don’t really remember too much of the next few hours. I remember lunging through contractions, I remember being on the ball, I remember the waves crashing in to me again and again.  I remember Avery holding me and then Diana.  I remember Diana behind me on the ball, holding me through the contractions.  I remember the contractions feeling like surges, like waves, I remember trying to think of them as orgasms, since that’s what they were only stronger and more definitive.  Perhaps that embarrasses you, but it helped me to cope because the strength of the contractions was getting stronger and stronger.  At one point, I almost started convulsing, just trembling with one particularly strong one, and I heard Diana say “Baby doesn’t like that Shannon, try to relax a little more” and I focused on that, on her voice, on her arms, on being held by the waves that overcame me.  I knew Marie came in, dimly knew, every so often to increase the pitocin.  I got up to 12 units, which O later told me was the most she’d seen anyone take without an epidural.

Diana and Avery held this space for me for very long time and O came back to check me.  Only 8 cm (later, they would tell me it was 7, who knows?).  O looked at me and said, “I need moore from you, stronger contractions, which we can get either with or without an epidural.”  They also thought that perhaps you were presenting incorrectly because, by this time, I really felt you inside of me, moving down along my back.  Usually, back pain means the baby’s back in against the mother’s spine.  In this case, it meant your big head was pressing into my spine.  We didn’t know that then or perhaps O would have suggested the c-section sooner.  I finally relented to the epidural, I could not withstand the pitocin any longer, and they withdrew the pitocin so the anesthesiologist could insert the epidural.  I was so scared.  Avery was with me, he held me as I sat on the side of the bed, by feet on his thighs our heads pressed together;  he held me as they told me not to move or I could be paralyzed.  He talked to me, somethinng, I don’t remember, images of Belize I think, while they inserted the needle and then the catheter of the drugs into my spine.  I felt cold.  And then heavy.  And then my legs went dead.  O had sworn I’d be able to push you out, to feel you enter the world, but I couldn’t imagine how.  I could not feel anything.  Every hour or so, Marie and then the new nurse after her would come in and roll me over with Diana’s help.  Avery would sit by me and hold me hand.  I remember sleeping, I was so very, very tired.  When they put in the epidural, I’d been in active labor for almost 18 hours, 3 of which was with pitocin.  It would be another 4 or 5 before you were born.

At one point, I told Diana I really, really felt the urge to push, I felt so full.  Marie came in and checked me, but still only 8 cm.  She said “Do NOT push, under any circumstances”.  O came in with Dr. R. and Dr. R. broke your water in an effort to get your head on my cervix.  Both she and O said you had been swimming in quite the ocean!  I didn’t even feel the water as it gushed over my legs, that’s how numb I was.  They had upped the epidural because I was feeling the pain of the pitocin.  Everything below my waist was a waste­land of feeling, expect I could feel you filling my pelvis.  I remember encouraging you, telling you to butt your head against me, like a little ram or antelope, to push, push, push your way out.  And I really thought you were, I really believed it.  I really wanted to believe it. 

Around 4pm or 4:30, O came in to check me.  Before she checked, she said she hoped for a miracle.  Avery and Diana helped hold my heavy legs.  I didn’t really feel her as she checked, I felt so full of you and so certain I could start pushing in just moments.  My cervix had swollen to 6cm.

How could this be?  I had trained to have you, I had assembled a support team to help me push you out into the world naturally, and now I lay completely drugged and numb, helpless, unable to push you anywhere!  I felt so very, very helpless, like you must feel when you’re crying to tell us you need something.  O basically said your head was too big for my pelvis, that a swollen cervix was a sure sign of this fact and an indication that my body was beginning to give up.  We had two choices: undergo an emergency c-section and meet you with open arms or allow me to continue laboring until either you or I or both of us were dead. 

I bawled.  I was so frustrated and scared.  Avery and I talked, him holding me and telling me it would be okay.  Diana held my hand while Avery went to tell my dad.  My dad came in and encouraged me.  Then, everyone cleared out and gave Avery and I a minute to process everything.  I was so scared, so anxious to meet you, but so, so scared.  I’d never had a major surgery before and I didn’t know what to expect.  I didn’t want to feel pain, but I wanted to feel you come into the world.

Then, the room was abuzz.  They wheeled me into the OR and began their preparations.  They upped my drugs, they moved me to a new table, they put up a screen, they brought in Avery.  He was all scrubbed up and in a mask.  They asked if I could feel a cool alcohol swab.  When I said no, they started in.  I smelt something burning, as they cauterized the incision.  O and Avery were at my head, holding me, Avery whispering all kinds of encouragement and imagery into my ear.  I felt pulling.  I felt tugging.  But no pain.  O kept saying “that’s your baby coming into the world, feel her come, you said you wanted to feel her and here she is.”  Then, one last tug and you were out.  They told me, but I knew, but I couldn’t hear you. I was so frantic.  Avery was away from me, O too, looking at you.  And you were so quiet at first.  And then.  And then.  I heard you.  You howled.  Your lusty little scream made me just cry.  I wanted to hold you, but I couldn’t move and they were sewing me up anyway.  O and Avery brought you to me and put your cheek to mine and that’s how I met you.  Your cheek was on one side and Avery’s on the other and I just wanted to hold you so badly, but I couldn’t move.  It wasn’t fair.  I wanted to look you over, but I couldn’t. 

And then you were gone.  Avery took you to the nursery for them to do their nursery thing while the doctors sewed me up.  I felt so empty and alone, I wanted to hold you so badly but I couldn’t. 

Finally, they wheeled me in to recovery.  And, after ages, Avery brought you back to me.  And the nurse showed me how to nurse you.  But I couldn’t feel you properly because my hands were still so numb.  I wanted to put you naked to me, to my chest, but I couldn’t move or command my hands to do more than hold and nurse you.  You were so smart already, nursing so quickly, and so precious.  I could not believe that your daddy and I made you.  He sat with me, holding my hand, looking at you.  I could have nursed you forever.

The rest of the night is fog.  The drugs, oh, I hated that they took those first hours from us.  You were drugged too, as those drugs pass on to baby, and you were very groggy.  I didn’t get my first proper, undrugged look at you until the next morning.  And my first memory of that morning is watching your daddy fall in love with you, just looking at you in your bassinet like you were spun glass.  He asked how he would know you were alive, he was so taken by your stillness in your sleep.  And he and I just gazed at you as you slept, this perfect little being we had created and nurtured and waited to meet. 

On one hand, I’m so thankful that I had the option of a c-section because I literally would be dead, and you along with me, had it been even 100 years ago.  On the other, it’s not what I had planned or wanted or envisioned.  My birth plan became a birth fantasy!  What should I learn from how you entered our lives?  I’m not sure yet.  O told me that clearly I didn’t need a natural birth process to be empowered; she thought that perhaps I needed to be humbled, to learn that even with all the research and homework done, life doesn’t come out the way we plan.  And while you might not have arrived exactly how I planned it, you came out exactly as I dreamed and hoped.  And I lived to see you.  I lived to build a life with your daddy and you.  And I’m very thankful for that.

Hear Shannon's scar's story here.

Monday
Apr302012

Cesarean Scar: Shannon

When I look at my scar, it says to me, "I know you didn't want me, but here I am, a reminder of dashed hopes and endless questions, a place of birth and love.  I am your paradox.  Someday, you will come to accept that I am a part of you."

When I touch my scar, it says to me, "I have healed, finally.  Your next baby will not use me to enter the world.  Massage me with love, release the tension, and I will direct your next baby's passage down, down, down and out."

I think the hardest part of all of this is that I do not belong anywhere.  The natural birth people turn their noses down at me (I have been yelled at by people who don't know my story); OBs and hospital types say I should have given in sooner and not been so proud.  I didn't plan it, I didn't want my birth to go that way, and I'm still not sure it had to.  I wish we could have afforded a home birth.  I wish I'd labored at home longer.  I wish I'd asked why they couldn't do something for a swollen cervix.  I wish... that more people understood.

Shannon's Birth Story

Monday
Apr302012

Cesarean Scar: Heather R.

To me my scar is a tattoo of my daughter's name.  Everytime I see it it reminds me of her, but everytime I touch it, it's just to scratch an itch!
 

Monday
Apr302012

Cesarean Scar: L.

 

To be honest, I can't see my scar. It is covered by a flap of skin that I can't get rid of due to having a c-section (unless I can afford plastic surgery, that is) I had to hold the flap back even to take this picture. When I look at this picture, I see something that shouldn't be there. I see the evidence of a failure to wait c-section. I see a doctor who tried to convince me that I could never birth a baby vaginally due to a *small pelvis* even though she was very wrong. I see everything that went wrong during my first birth.

It says, it is numb and hypersensitive all at the same time. On occasion, it still hurts even though it's been over 5yrs. It is bumpy and uneven and thick as my pinkie finger. It is indented in some places and bulges in others. It says, it is ugly. 

Monday
Apr302012

Cesarean Scar: Sarah V.

 

The first picture (above) was 2 weeks postpartum. Both ends of my incision became infected and opened up. I was back in the hospital for 3 days on IV antibiotics.

 The other 2 pictures I took today, 7 months postpartum (to the day). I have a small 'bump' above my scar that hasn't gone away.
 
I would say my scar says "look at me, I want you to remember what you had to go thru during labor and surgery so you don't forget how hard of work you did to get your baby girl out into the world!"
 
My scar says "I feel funny when you touch me. I'm not numb anymore but I'll remind you from time to time that it still isn't comfortable for me when you wear jeans."
 
My c-section was unplanned and I had labored for 19 hrs after my water broke on its own, then pushed for 1 1/2 hrs. After the help from a vacuum she still wasn't coming and her heartrate started to drop with contractions so we had to do a c-section. My pelvis was too narrow for her to fit thru. 

Monday
Apr302012

Cesarean Scar: Nastassja H.

 

When I look at my scar it says, "Don't look". It hides under a flap of skin that no diet or exercise will rid me of. I glance past it quickly, it's hidden, why think of it? Why look at it? Why think of how my body will never, ever be the same there? My body has changed in many, many ways in the last few years. I have other scars. Scores of stretch marks, flab that my bony teenage self never dreamed she would bear. I drink it all in easily, before the mirror. I don't spend any inordinate amount of time wondering what others will think when they see it. If they will be disgusted. Stretch marks are normal. Having your appendix out isn't too weird. Heck, that appendectomy scar is kind of cool! Want to see?

But my scar hides. Even in a skimpy swimsuit, it's invisible. Even naked, I have to pull up my belly to see it. And that makes it easier, not having to look at it all the time. I can almost pretend it's just a fold of fat.

It says that I should have done something different. It says that knowledge is not enough to save you. It says that acting on knowledge is hard, so hard, when you are alone, and everyone is telling you it's ok, it's not a big deal, sometimes it happens this way, you tried it all, it's time to let THEM try. Time to hand over the reins of your body to the experts. They know the buttons to push. They can make it work.

And I believed them.

When I touch my scar it yells "DON'T TOUCH!". I cringe and grimace. My muscles tense. Sometimes touches hurt. Sometimes they don't. It has been years, and my subconscious says that it's still not healed. "Don't touch! Be careful! You just don't know what will happen if you press here, or push there. It may hurt!"

The worst part is I've proven to my scar that it's fine. I've carried another healthy, beautiful child, in that scarred uterus. I pushed him into this world with minimal fuss and to-do. Working as intended! Fully functional!

But oh so fragile. Please don't touch. Will my scar ever believe it has healed? 

Monday
Apr302012

Cesarean Scar: Kim - 11/11/05

My name is Kim, my surgical birth was on 11-11-05. I do not have a picture of my scar, I don't know what my scar looks like, and I don't touch it.

I was pregnant and in my 30th week of pregnancy with twins. At a "routine" appointment, I was told that the babies and I were in a great amount of danger and I could not go home, I was told I had HELLP. I spent almost a week in the hospital on a half dose of "mag" when the window began to close. I was informed that the time where I was healthy enough and the twins were big enough was getting smaller. I was transfered to a different hospital, my contractions "broke through," my water broke, and baby A began to deliver breech; rapidly. I was taken into surgery, given an ineffective epidural and surgery began. I could feel the cutting, began screaming and was then basicly paralyzed by medications and fear. I was in a twilight state and have a small memory of the babies being held above the sterile field, they were then taken away to the NICU. It was a week before I held my boys, I had complications from the epidural and complications from the complications. The surgical birth was the most horrific event in my life. I don't believe I gave birth to the twins, I feel they were taken from me. I had a very hard time bonding with them in the begining, the NICU made it harder. I know I was pregnant, but really they could have been hatched.


I don't touch my scar, it hurts often, aches or burns, I stay way from the scar.


My boys stayed in the hospital for 4 and 5 weeks, I was able to get them off of the formula and were 100% breast fed until solid food was introduced. They continued to breast feed past their 1st birthday. They are not behind too far in size and are up to speed everywhere else, minus slight speech issues. The older 3 kids love the boys and everything has come full circle, better than I would have dreamed.

But my scar is something I do not and can not visit.

Monday
Apr302012

Moving CesareanScar.com

For a variety of reasons, I'm moving the CesareanScar stories and photos here to my Navelgazing Midwife site. I think there will be more interaction that way and women's stories deserve to be heard.

It will take some time, but look for the entries to begin being moved.

Sunday
Apr222012

Waterbirth Revisited

Let’s just say, I’ve seen some awesome water births. Peaceful, lovely… the baby sliding out of mama and being caught in her hands just before total ejection… then being lifted to –and out of- the surface, pulled into his or her mother’s breasts for safekeeping. Heartwarming at the very least.

But, as I’ve been re-evaluating all the different aspects of home and hospital birth, I couldn’t let water births go without examination.

There is no doubt that being in the water is calming for a mom, allowing the uterus to “float” off the nerves, diminishing pain considerably. “The midwife’s epidural” it’s been called and I would attest to that many times over. But what of the ick that is a common and pervasive part of birth? “Ick” being bodily secretions like urine, feces, and mucous. We might include blood, sweat, tears and possibly even saliva, even though most people don’t think of those as being too icky.

Mind you, I’ve never had a problem with bodily secretions during birth. (Well, except for that one time when I co-barfed in a metal bowl during one woman’s transition.) Poop, pee, vomit, sweat, saliva, tears, blood, mucous… none of them remotely bothers me… so while I use the word “ick” it isn’t so much that I think of them as icky, but know that, as we delve into the topic, many reading will find some of the normal bodily functions icky, especially when discussed in conjunction with birth.

During birth, it behooves a woman to abandon any societal restrictions she has about bodily functions. That requires a trust in her care providers and a belief that everything she might emit is normal, unless told otherwise (too much bleeding, for example). In fact, midwives are a hilarious bunch that find bodily functions applause-worthy. “You threw up? Fantastic!” or “You’re having lots of loose stools? Great!” And that isn’t to help a woman feel comfortable in her emissions, but because the various actions are positive signs regarding the progression of her labor. Loose stools can herald impending labor and throwing up can be a sign of transition. Women like to be told they are progressing in their labors; bodily secretions can give everyone wonderful clues about those progressions.

But what if the poop and vomit were in the birth pool? Oh, women don’t vomit in the pool, you say? True enough, but they do vomit in the toilet (or whatever is barfed into a bowl goes into the toilet). Poop and pee go into the toilet usually, too. But, in birth, both of those can –and often do- happen in the pool.

This is where I started re-thinking waterbirth.

If mom pees and poops into the pool… and a baby is born into the pool with poop and pee… is that gross or is that not gross? For ages, our birth kits included a fishnet to scoop poop out of the pool, but hasn’t the poop already contaminated the water? And there isn’t a fishnet small enough to get liquid poop or urine out of the water… what of that?

When women have asked these questions, we’ve appeased them with, “it’s diluted to almost nothing” or “it’s only yours,” but are these adequate? Or even true? What if dad gets in and can’t get out to pee? And does dilution make it any better? All kinds of stuff can be in poop and pee, including e coli and group b strep. Do we want to dredge our newborn child through those possibilities?

We poop and pee in the toilet every single day. Would we dunk our child in that water… even after flushing? The thought is nauseating. Why then is it okay to have our newborn come out into the ick of a birth pool?

Suddenly, I understand the requirements of so many birth centers and hospitals to only allow labor in the tubs, but birthing out of the water. I always thought that was a dumb rule and even heard the arguments about why without really thinking the whole thing through; the baby is born in a toilet bowl. Isn’t that kind of gross?

I remember one dad who was in the pool with his wife and as soon as she let him get out, he ran to take a shower even though he had a newborn to cuddle with. We all thought it was kind of silly, but on second thought, did he have the right idea and the rest of us were somewhat deluded?

I used to think I’d love to have a waterbirth. Now, not so much. How have you been able to wrap your head around birthing in a tub with poop, pee, mucous and blood? I look forward to what folks have to say.

Tuesday
Apr172012

Doulas & Advocacy

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?

Sunday
Apr012012

"Questions to Ask About Homebirth"

That was a recent post by Peggy O’Mara of Mothering Magazine. While I have long admired Ms. O’Mara… her words got me through many difficult parenting moments over the years…, I felt it was important to address this specific post.

After highlighting the safety of homebirth (many of the studies are, of course, debatable), she lists questions to ask your prospective homebirth midwife. What’s challenging about this, however, is that she doesn’t say what the answers should be. How is a novice birthing mom supposed to know what answers she needs to hear in order to have a safe birth? Does she go by what the natural birthing sites say are the right answers? Does she go by the medical standards?

How does she find the middle ground (if that’s what she’s looking for at all) –or the safest ground- if everyone answering has their own agenda?

I recently wrote a series of posts on this topic, but I felt it was important to address this again since it seems the more natural side of the coin has begun to understand women might want more than the standard, “Are you a hands-off midwife?” question.

Here are Ms. O’Mara’s questions in italics. My answers that might clarify things in standard text.

What is your midwifery education and experience? What certifications or licenses do you have?

What does she think the answer should be? An apprenticeship only? A Certified Nurse Midwifery education? A MEAC-accredited school plus apprenticeship? Knowing what the most education and skills training should be is crucial to answering the question.

How long have you been practicing? How many births have you attended?

Instead, “How long have you been practicing as a primary homebirth midwife?” is the way to ask that question. And instead of how many births have you attended, the question should be, “How many births have you attended as a doula? As an apprentice? A midwifery assistant? How many births have you been the primary midwife with supervision and then without supervision at a homebirth for? How many years have you been a primary homebirth midwife?”

Asking how many births have you attended allows a woman to fudge on her primary homebirth experience, leading the mother to believe she has been the primary for far longer and for far more births than she has been. I did this myself; I am clear it is done all the time. This does not, in any way, discount the midwife’s experience as a doula, especially as a doula in the hospital, because she will have seen aspects of birth she would rarely (if ever) see in a homebirth practice. Complications occur more often in the hospital, whether iatrogenic or not, they are still complications the later-on midwife will have seen and watched handled, adding to her overall education. Not skills training, but merely observational experience.

I can’t stress this enough, asking the midwife more pointed questions will give the woman more information than just, “How many births have you been to?”

But, what should the answers be? Because there is no standardization in midwifery education or skills training, the answer depends a lot on the woman.

In my opinion, arbitrary as it might seem, I believe a midwife should have at least a hundred births in the hospital as a doula or at least observer of much of a labor, birth and immediate postpartum time in the hospital. Some could be at home, but seeing more complications adds to the woman’s education more than learning how to sit on one’s hands. I also think the midwife should have about 40-50 assists and then another 30-40 as a primary with supervision before being let out on her own. Hiring a midwife who’s had this level of experience would make sure she’s had at least a couple of shoulder dystocias, hemorrhages, malpresentations and other more common complications, including several transports as the primary with supervision. Being the primary midwife with a more experienced midwife overseeing her is one aspect of midwifery skills training that is glaringly missing. More on this in another post.

Who is your midwifery back-up? Who is your medical back-up?

This is more a logistical question. While it’s important to know the education and skills training of the back-up midwives, it is rare the back-up midwife will be the one the client ever sees. Unless the potential midwife takes on more than 3 or 4 clients a month. In that case, be sure to interview the back-up midwives, too, asking these same pointed questions.

A note about pointed questions:

If you are embarrassed to ask the questions lest you offend the midwife, stop it. Any midwife who bristles about these questions needs to be left in the dust. She should have complete composure, no defensiveness and be clear and truthful in her answers. If she can’t act professional with you, how will she act with a doctor in front of her if you transport? It’s a midwife’s job to answer these questions; it’s your right to know the answers.

How often will I see you during my pregnancy? How long will prenatal visits last?

Truly irrelevant as a question. I’ve never known a midwife to see clients on anything different than the standard monthly until 28 weeks, bi-weekly until 36-37 weeks and weekly until the birth. Plus, appointments are almost always 45-60 minutes long, most of the time being spent on social interaction… getting-to-know-you aspects. The actual medical/technical part lasts less than 15 minutes. When going to an OB, the social aspects are what is missing. I’m not discounting the importance of a homebirth midwife knowing you and your family better. In fact, the appointments help the midwife know how you handle stress and learn the nuances of your personality, but they are not the meat of the prenatal appointments. Again, the length of time is the question and these two questions are, in my opinion, fluff and can be dropped from the list.  

How will my partner (and children) be involved in prenatal visits, during labor and at the birth?

They will be as involved as you want them to be! Another odd question that is pretty irrelevant in a homebirth setting. What midwife is going to say, “Your husband can’t do anything but sit there”? None.

Will you provide me with nutritional guidelines?

This is standard midwifery care. Dump the question.

What is your philosophy about prenatal testing?

How are you supposed to know what answer you’re looking for? Instead, research and you decide what you want to do. Do you want the AFP test? Tell the midwife that’s what you’re doing. If she balks or tells you it’s unnecessary. Listen to her side of it and if you still disagree and she tries to talk you out of it, walk out. If you don’t want the test after researching and she believes it’s necessary, listen to her, decide if you want it or not and if you still disagree, leave. Don’t waste anyone’s time because if you disagree on something as small as prenatal testing (and the AFP or even prenatal testing doesn’t have to be your litmus test; pick your own), there will definitely be other things that you won’t gel together on. However, if she accepts your decisions gracefully, there is hope for an amicable relationship.

Do you offer childbirth education classes?

Who cares? You can find childbirth classes anywhere.

Will you suggest non-drug soothers, and different positions during labor?

If you’re interviewing a homebirth midwife, you will have someone who suggests “non-drug soothers” (what an odd way to say non-medical pain relief) and different positions in labor. The only midwife I can think of who wouldn’t would be a staunch hands-off midwife and you were asking a test question to see how hands-off she really is. If a midwife doesn’t offer assistance, she is, in reality, not being much of a midwife at all.

How long after birth is the umbilical cord cut?

This might be a relevant question during the pregnancy, but seriously, not as a midwife determination question. You can discuss this and any midwife worth her salt is going to adhere to your wishes and really, most midwives that I know do not cut the cord early at all. If anything, the medical establishment would have hairy cows about how long a homebirth midwife leaves the cord attached. (Wrongly so, too.)

How long will you stay at my home after the birth?

This is so arbitrary it would be hard to get a real answer. Perhaps the right answers are: “As long as you and the baby need me.” Or “Until you and the baby are stable and you are able to take care of yourself.” That doesn’t mean you might not need help, but if you need help getting to the bathroom because you’re continuing to faint, you need to be in the hospital. (Fainting once, especially after peeing, isn’t the most unusual. However, if you have bleeding and faint, that is a serious red flag and needs to be addressed.)

What emergency equipment do you carry?

Finally, an important question! But I’d expand it to “What equipment do you carry?” The answer should be: Doppler (preferably waterproof) with extra batteries, blood pressure cuff (two sizes), thermometer, glucometer with in-date supplies, lancets, IV equipment with in-date fluids (Lactated Ringers, Sodium Chloride, Dextrose 5% Lactated Ringers are the most common types of fluids needed in birth), in-date Pitocin (which is supposed to be kept cool), Methergine (IM and tabs), Cytotec (for postpartum hemorrhage), in-date lidocaine, in-date sutures of at least two sizes (one smaller one for the labia), in-date Erythromycin eye ointment and Vitamin K for the baby, in-date antibiotics for GBS+ women, scissors, needle holders, forceps (not the kind that pull babies out), oxygen (I always carried two tanks… one for mom, one for baby), a bag and mask with new masks for each baby (they are marketed as disposable; most midwives I knew re-used the masks [after cleaning]), in-date blood draw supplies, in-date catheters, a Sharps container… I may have missed something… anyone else think of something?

While it can be hard to know what answers you’re looking for when you ask a midwife about various complications,  it is easy for midwives to show their integrity and trustworthiness by their equipment and not-expired medications and sutures.

Again, if you’re worried about insulting her by asking these questions, that’s what you need to look at… and whether you’re ready to have a homebirth or not. Any midwife worth her salt will welcome these questions. If the woman in front of you balks, get out of there. Fast.

What back-up hospital do you use? Under what circumstances do you transport? What is your rate of hospital transport?

I’ve always felt these questions were kind of odd. The list of transportable reasons is endless and it’s the midwife’s job to know what they are. Listing them all out for you, you might as well read William’s Obstetrics (an incredibly technical book). The midwife will surely say something like, “Breeches, twins, high blood pressure, a fever...” things like that, but do you really want to hear, “If there’s unresolved tachycardia, if the baby’s baseline fetal heart tones continue declining, if mom can’t pee for several hours (and the midwife can’t or doesn’t use a catheter), if mom won’t eat for a certain length of time (to be determined in the moment),” and the list, as I said, is endless. We’re hired to know when to transfer (non-emergency) and transport (emergency).

A back-up hospital? How about, “What hospital will I go to in a transfer?” In a transfer, picking a hospital can be done. However, in a transport, the ambulance decides almost always.

Regarding what the hospital transport rate is, this can be taken any number of ways. Low transfer rate? She only takes very low-risk women, maybe none who’re having their first baby. Or, maybe she stays home hoping complications will resolve (which often enough do, but that’s just luck and not something to gamble on) or she’s afraid to transport. Maybe she has a lot of experience and takes appropriately low-risk women. How are you to know why she has a high or low rate of transfer? You can’t; it’s all in how she sells herself.

I hope these discussions are helping.

Friday
Mar302012

Medical Board vs. Dr. Biter

Here's the most recent public information about the allegations against Dr. Robert Biter, a doctor I previously supported here in this blog.

As you read, know that the patient "LS" is a dear real-life friend of mine and the information you see about her case is a fraction of what actually occurred. Having had a baby with Dr. Biter before the birth discussed here, she is just as shocked and disillusioned as I continue being about the whole thing.

It seems there will be a Hearing in June where some sort of ruling will be given. That's the word on the street anyway.

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