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Friday
Mar302012

"Big Healthy Babies"

The headline read: “Record Breaking Baby Born at Paoli Hospital” and then the abbreviated story of one mom’s birth of her extra-large child unfolded.

“Six-day-old Blake Alexander Ciarlone is the new biggest baby born at Paoli Hospital, according to available records dating back to 2002.

“Born to Allison and Daniel Ciarlone, he was 12 pounds nine ounces, beating the previous record, set last year, by two ounces.

“Blake is Allison and Daniel’s second child and follows the trend set by his 2-year-old brother, Landon James Matthew Ciarlone, who was born at 10 pounds 13 ounces. Both births were planned Cesarean sections because Allison was getting too big. Blake was born four days early, and his brother Landon was born two weeks early.”

I posted the story on my Navelgazing Midwife Facebook Page and surely made some comment or another about the mom having Gestational Diabetes. Often when these articles come out, there is a disclaimer inside the piece stating, “Gestational Diabetes can cause babies to be this large, but <mom’s last name> did not.” Or, “Baby Ciarlone was born healthy.” In this article, we get a hint about mom’s diet during the pregnancy, unusual in these stories.

“Both were pretty normal pregnancies, said Allison. She ate what she wanted, but it wasn’t anything excessive…. ‘I guess I just carry big babies,’ she said.”

Does she?

Here unfolds the discussion and I’ll answer the questions directed at me as we go along even though it becomes clear I didn’t answer during the discussion. These interjections will be in italics.

JT: Is it just me or are these stories getting more and more common?

KBH: They are! I have seen so many news articles and stories of babies 10lb+ lately who are obviously macrosomic, etc. and it's driving me nuts! Every single one, mom is "I guess I just make them big." Really, really wish people would wake up and realize that this is an issue!

CG: "big healthy baby" /sigh. Big doesn't mean healthy.

TWJ: But big doesn't necessarily mean unhealthy either. Just a thought.

SS-R: There's a difference between a "big, healthy baby" and a "macrosomic baby". Unfortunately, most news stories don't differentiate. I've seen a 10lb+ baby that was lean, stocky and long. Both parents were tall and stocky, with mom hovering around six feet tall and dad towering over her. Baby had great APGARS and perfect blood sugar. THAT is NOT the typical "biggest baby born" you see cropping up in the news.

HH: "Since she was measuring about 40 inches around (t)he waist at 36 weeks, her doctor “didn’t want to take any chances,” said Allison."

I am confused… I was almost 60 inches with my last. What's the big deal. (This was referring to: “Since she was measuring about 40 inches around he waist at 36 weeks, her doctor ‘didn’t want to take any chances,’ said Allison. They planned the cesarean section and were expecting another 10 pound baby, but were surprised by the extra two pounds.”)

Also, not to be rude, but she is a plus size momma. 40 inches isn't that big of a waist. Was she a size 5 before the pregnancy or something?

I can testify... I make big babies. My last was 9'13. I only gained 35 lbs and NO GD. Big can be healthy.

I wonder how much weight she gained.

NgM: It’s important to know that diet is not the only way to control GDM or IR. Sometimes it takes medications as well. I’ve known women to be meticulous with their diets and still have 10+ pound macrosomic babies because their pancreas needed more help than just the dietary changes. The diet certainly helps in these cases… imagine how large the babies would be without that help from mom… but the baby sometimes needs more help than even mom can offer.

KL-D: Is there any indication that this baby wasn't healthy?

NgM: A baby that big is, most assuredly, not healthy. ‎HH: There can be Insulin Resistance long before GDM and IR affects the size of babies, too. The GTT is an archaic screen/test, the best we have at the moment, but it doesn't catch all cases of IR (the lower limits catch some, however). ‎HH: They meant fundal height, not waist measurement.

TS: So, stupid question maybe for NGM-- if a mom is diagnosed with GDM or insulin resistance and is untreated aside from changing one's diet, is it possible to have a normal-sized baby?

NgM: No question is stupid! However, I’m not sure I understand this one totally. Let me try, though. If mom IS diagnosed with IR or GDM and changes her diet, is it possible to have a normal-weighted baby? Absolutely. If mom is diagnosed with IR or GDM and changes her diet, is it possible she might still have an LGA or macrosomic baby? Absolutely, because of the possibility of the pancreas needing more help than diet can offer… mom needing medications to help as well. Did I answer that right?

We don’t talk about it enough, but it isn’t just diet… there is also a huge part of the puzzle with exercise. Exercise helps the pancreas metabolize the food in many different ways. Simplistically, it gives the pancreas more power to shoot out the insulin as well as burning some of the food through energy expenditure instead of it needing to be metabolized with insulin. If pregnant women walked for 15-20 minutes after each appropriately sized meal (and appropriate carbs!), it can make or break an IR/GDM experience.

AKS: TS, I believe the answer has to do with tight control of blood sugars, which is sometimes possible via diet and sometimes not.

Also, I have a friend who just had a 9 lb. 2 oz. 23 inch baby. Definitely no GD--she tested her blood sugar 4 times/day before the GTT, which she passed. Baby had heel sticks after birth, zero blood sugar problems. Maybe some women really do grow big healthy babies? They just don't make the news?

NgM: Depending on who you ask, 4000 grams (8lbs 13oz) or 4500 grams (9lbs 15oz) = LGA or macrosomic (two different definitions, by the way, but often used interchangeably), so 9lbs 2oz would barely fit one description and not the other one at all. I hardly waggle my eyebrows unless the baby is over 4500 grams. Unless mom is under about 5’5”.
Also, I’ve read in diabetic literature that testing four times a day is hardly adequate to determine how a person’s blood glucoses are doing in any 24 hour period. Even four times a day and the HgbA1c together won’t track the ups and downs that happen throughout the day. 10-12 times a day is a more accurate number of finger sticks needed.

This is why I’ve wished the three day continuous monitor might replace the Glucose Screen and GTT. The continuous monitor measures glucoses every 3-5 minutes for three days. Now that’s accurate! Here’s a great explanation about why the four times a day and the HgbA1c aren’t the most accurate ways to gauge BGs.

CS: This is the topic that had me hooked to NgM :) I ended up on her blog a few months ago for something entirely unrelated, and went to bed that night with a sigh of relief. I knew I had big babies and I always knew there was something not right. Hearing that IR can cause macrosomic babies was the light bulb I needed in this pregnancy. It makes sense. I'm 5'2, and both dads are 5'11 and under. So I always questioned where 9lb 2.5oz 23" and 9lb 5oz 24" babies came from. I hated hearing that I just made big babies, but it was a mantra I began to accept. My second son is huge. He's the size of his 4 year old brother. If I was going on just him, I'd agree I made big babies. But his brother normaled out quite quickly after birth. My first had a perfect APGAR, my second had a 7 and they took him to the nursery and his sugars were off. Add that with my dad's diabetes diagnosis at the beginning of this pregnancy, and the pouch around my middle that I can't get rid of, and I believe that I fit the category of IR macrosomic baby maker. Up until getting sick over a month ago, my diet was great. But I've gone off the diabetes lifestyle change as it was harder to maintain while battling chest infections with little sleep and raising my boys. I'm 24 weeks now, so I'm hoping to be healthy enough soon to regain my energy levels so I can change my lifestyle again and hopefully better my pregnancy, delivery, and my daughter's future. Thank you NgM for your logical and informative information on this subject. I wish you were able to reach more women on the subject.

Also, what was the test you recommended again? The one that tests 3 months worth opposed to the blood glucose level test? I'm going for the routine one next week and I don't suspect anything will come of it, but whether during pregnancy or after, I want to take that test just to see.

(Ps. I thought it was funny when my midwife asked if I wanted the glucose testing, I told her yes, but that I already changed my lifestyle based on the information I read on your blog. She smiled at me and nodded. She totally knew who you were and was supportive of the same information you speak of! Just thought it was cool that you are that well known up here in Canada too!)

NgM: Hilarious! And I’m flattered.

KDK: A1c is the more accurate test.

NgM: Yes, the Hemoglobin A1c is another measure of how a woman’s glucoses are doing, but it can only see from the point of the test backwards three months. Therefore, testing in pregnancy is good for observation, but not for diagnosing GDM. The reason the GD screen and GTT are done about 28 weeks is because that’s when the mechanism for pancreatic stress takes effect. While it seems gradual, it wouldn’t be surprising if it was a light switch reaction to the pancreas hitting its stress limit. Not diabetic one day and diabetic the next. Doubtful, but sometimes it’s easier to visualize what happens if you think of it that way.

But we know that Diabetes is a spectrum, it’s a ramping up of glucose in the blood because the pancreas gets more and more exhausted trying to keep up with metabolizing food intake. That’s why there can be tight control over food and exercise, but the pancreas still needing more help with medications because mom can only do so much. Diet and exercise are crucial… taking meds instead of changing the diet and exercising is inappropriate and probably pretty ineffective… but together, it can be awesome for the mom and baby.

SS-R: At 60, my mother has no signs of IR or Diabetes, she had four babies ranging from 9lbs even to 9lbs 15.5ozs. Diabetes in all its forms is virtually unheard of in our family at all, in fact. MOST babies born on my mother's side of the family are between 9 & 10 pounds (big, but generally not considered macrosomic). I think we need to be careful to distinguish between the two. There is such a thing as big and healthy, and I think we are going to be seeing more and more of it as people are eating better during pregnancy, as humans get taller with each generation, as smoking decreases- both during pregnancy and prior to it. There are a lot of things known to contribute to SGA babies, even in a good-sized baby, those things- or the lack of them- can cause a variation of a few ounces one way or the other, and when you are talking about people with a family or genetic disposition to babies that are on the upper end of that size bell curve, a few ounces can make a big difference.

That said, I am not one of the people who believe that all big babies are healthy, or that GD doesn't exist. I simply think we need to be cautious not to be diagnosing mothers and babies with medical conditions based on a single factor and without access to their medical information.

S: as I pointed out in my previous comment (and if someone could link the blog post where NgM discusses this in full) I kind of have a triple threat against me. I may have self-diagnosed, but it's not affecting my life. It's a lifestyle change that really is a billion times better for me. Diabetes can hit anyone at any time, regardless of genetics (although usually they do play a part). I would rather change my lifestyle now and possibly have a smaller baby (less traumatic birth) and possibly avoid becoming full-fledged diabetic later in life. Some women obviously make big babies. Genetics is great like that. But, the 3 strikes were that I had one child who was born large but who normalized after birth (i.e. he wasn't that high in the percentiles, but rather quite normal), diabetes runs in my family with my dad being diagnosed quite recently, and I've had recent weight gain (mainly in waist area). One thing on that list doesn't necessarily mean IR. It doesn't mean that it's not IR either, but I firmly believe that with each checkmark on the list, the chances are increased immensely. I think more needs to be studied on this to help more women. Diabetes is awful on its own, but to know what it does to your heart and the rest of your systems is enough to want to avoid it at all costs. I don't ever think that NgM is throwing everyone under the big babies = undiagnosed IR or worse bus. But I do think that her way of thinking could change the face of pregnancy and even diabetes as we know it for the world over.

LA: Seems to me that generalizations do one thing: hurt mom and babies (yeah, generalizing about generalizations).

There are big healthy babies. There are big unhealthy babies. There are small healthy babies. There are small unhealthy babies. ...There are many in between.

Lumping Mommas and babies into predetermined risk categories based on generalizations and assumptions is killing maternity care in the US. It ties everyone's hands. I don't understand why providers perpetuate one size fits all care. Who benefits? Not me. Not my kids. Lazy, CYA based medicine. Hmmm. There ya go.

I have 10-11 lb babies. In nearly 15 years of having babies I have never shows signs of or tested remotely positive for diabetes or IR (not GD bullshit, real diabetes). I have no family history of diabetes. I have children who have remained in the 90th + percentile to off the charts into their teens.

I grow big, healthy, strong babies and they grow into big, healthy, strong kids. My family has lots of big, healthy long lived adults.

Maybe those providing maternity care need some diversity training and lessons on genetics.

NgM: The size of your babies alone puts you at risk for future diabetes and unless you stay active and normal-weighted, you could very well end up with diabetes, too. It’s great you’ve avoided it so far, but I find it incredibly difficult to believe your babies were that big without any IR issues going on. But, that’s part of your argument, right? That I (and other providers) lump you in with the others… so ‘round and ‘round we go.

SS-R: C- I was in no way directing my comment at you. I was speaking about how quick some people are to call every large baby unhealthy when ALL they know is birth weight. In fact, I would be MORE inclined to give credence to your strong sense that something was off than to the medical professionals that told you everything was fine. If you were my friend and you were telling me this, I would PUSH you to fight for answers and to trust your gut.

I also think that IR does need to be taken into account, especially given the rise we are seeing in PCOS and related issues being diagnosed, and more attention needs to be paid to nutritional counseling prior to and during pregnancy than simply the 'weigh and shame' routine that many moms encounter.

CS: I think the problem is simply the testing for GD doesn't screen for IR which can cause problems much the same. To know that and to see big babies being born and to hear statements like "She ate everything she wanted" (which usually equates to salt and sugars... not many people make that statement when referring to copious amounts of fruits and vegetables and steak), you can't help but wonder. I don't think she is throwing this mom or anyone else under the bus, but raising an important topic of concern. How many babies are born that big where it is genetics? Are they still truly healthy or is there lower APGARS, messed up blood sugars, or even outside of just birth, what are the risks in the future? And if it's genetics, can diet and exercise (assuming there is no true GD that requires insulin) bring the size of the baby into normal parameters to minimize the risks? Or does genetics truly determine that the baby will be large no matter what (and presumably healthy)? In which case how can screening be done accurately to risk out women who do have undiagnosed IR? Can studies be done to prove the risks associated with living a lifestyle that creates a larger baby in that case?

So many questions, so many theories, and I think everyone just wants happy, healthy babies in the end. But I'm happy that someone is asking these questions and getting people talking about it. I'm kind of ill right now and heading to bed, but I'll try to find the link to NgM's blog entry on this. She does mention the 3 strikes rule instead of just focusing solely on the big baby aspect. Like I said, I have 3 strikes against me. It doesn't mean I have IR or will most certainly develop GD or DM, but it does light a fire under my bum to make some needed changes in my life. Do I need pop? Nope. Do I need 4+ teas with 2tsp of sugar every day? Nope. Do I need more exercise? Certainly. Living the lifestyle like I have diabetes isn't limiting at all. In fact I never felt better and I'm sure I was increasing my quality of life as well as my life expectancy. Even if the testing comes back that I'm not even IR and even if I just do make big babies, I'll still be thankful for the motivation to change my life and my habits as it can only be making my life better:)

MM: I had diet-controlled GD with my first pregnancy - my sugar control was spot on and I delivered a healthy 9lb 7oz boy. I figured he was big due the GD but my second, with absolutely no GD was 9lb exactly. My last, again with absolutely no GD, was born at 37 weeks, perfectly healthy weighing 7lb. By his due date he was 9lb. I've come to the conclusion that I do just make big healthy babies. They stay big til about 6 months, and then they even out to average size.

NgM:This was a great conversation, ladies… thanks for exploring it more in-depth. It certainly is one of my favorite topics.

Thursday
Mar292012

The Cursor

The cursor blinks at me
Like a finger tapping its impatience.
I write a few words,
Then they fall off the edge of the page.

I ache to compose,
But gathering, then assembling
My thoughts
Seems overwhelmingly difficult.

Please forgive my poor neglected blog
(as I have come to call it).
I hope to find my way back to it soon.
I miss her as much as she surely misses me.
Thursday
Jan192012

Responsible Blogging

Angela Horn, on her new blog Doula2You wrote a post entitled, “Ethics in the Childbirth Blog-sphere” (sic) about the responsibility a blogger takes just by writing her (or his) words on the Internet. 

“When we proclaim ourselves as experts, by certification or opinion (blogs) we are responsible for our words. We have an obligation to our clients and/or readers to provide accurate information and to disclose our bias. When we conduct ourselves as experts in a particular field many followers of that field will trust what we say and take it as fact. While I don’t disagree that readers have the obligation to do their own research and make their own informed decisions that doesn’t absolve the birth advocate/blogger of the responsibility for their own words and how they are presented.” 

This topic comes up every few months, especially when someone took the advice of an online “counselor” and had a negative or even tragic outcome. Women who let their pregnancies continue past 42 weeks or who have Unassisted Births with a breech baby readily come to mind; certain “natural birth” community forums leading the way against safety and, all too often, even common sense. What is it that makes it so easy to take a stranger’s advice when real life advice says otherwise? I’m reminded of second (and third) opinions… continuing to ask for “opinions” until someone finally says what you want to hear. “Aha! See! I was right after all!” When it comes to childbirth, ask ten women what they think and you’ll get fifteen answers. Eventually, you’ll hear what you wanted to hear in the first place. 

But blogging isn’t quite a community forum. Bloggers taking on a more serious tone, sounding more professional, when, in fact, all we bloggers really are are darn good writers (for the most part). We don’t necessarily know any more than anyone else, we’re just good at getting the information out there. And yes, myself included. 

So, do we bloggers have a responsibility to our readers? Do we need to put disclaimers on each post saying, “This is my opinion. To figure out yours, read and research a LOT. Do not just take my word for it.”? 

I’d love to hear from the women themselves how they think we should present ourselves, how we remind women we’re human, too, and don’t know it all (despite some believing they do). How do we demonstrate our specialties while also showing our warts? Is it only through time that someone earns respect?

What do you think?

Wednesday
Jan182012

What Should a 4-6-Week Miscarriage Be Like?

This was a Facebook question I thought would translate well here. Here’s how the thread unfolded. 

A mama asks: What should a 4-6 week miscarriage be like? (bleeding, cramping, clots, etc.) 

CDM: Mine was like a normal period, but I'm not sure if that is the norm or not. Had I not taken a test on a hunch I would just assumed it was my period starting a little late. Sorry for your loss, mama. 

HH: I just miscarried at 4w5d. It was heavier than normal, lots of larger clots (dime to nickel size), and painful cramps. I never have clots or more than light cramps. I also had a migraine that lasted 3 days. 

SMP: Please visit http://stillbirthday.com/. There's a lot of info there about what mother's go through, symptoms, and support for when this happens as well as thousands of mother told stories. Stillbirthday also lists doulas for moms in this situation and we are all very nurturing and caring. Sending good thoughts for this poster. 

MA: Sorry to piggyback on this question, but could answers please also include a 7-8 week miscarriage? Thank you. 

BO’B: All of the above.. but they can be so different for everyone.. I think even the two-week difference of 4 weeks to 6 weeks changes things. My 6.5 week miscarriage was like a very heavy and very crampy (VERY emotional) period, with a definite day of passing larger clots and greyish matter. Probably two weeks total. 

KL-D: Mine at 5w1d was much heavier than a period and longer. I bled for at least 10 days on and off. I also passed some obvious tissue with the clots. It will depend on the reason probably (blighted ovum/empty sac/chemical pregnancy will probably be less bleeding and clots than a clinical pregnancy with a fetal pole observed, but I'm just guessing there, mine have all been clinical.) 

Also sorry for your loss. It sucks. 

SCM: It'll be an extra crampy period, will probably last a few days longer than normal. I've got six of those under my belt. ((hug)) 

MW: Just had mine in July....nobody told me what it would be like and I thought the unstoppable bleeding for days and days enough to back up all the plumbing in my house (it was a mess) must have been normal since nobody would tell me ANYTHING. It wasn't. If anything seems wrong it probably is.... go to the ER and MAKE them bring in the on call OB. It took 3 visits before I finally forced them to do something and the OB is the only one who could finally tell me I had miscarried 4 weeks earlier and had to go in for an emergency D & C. The regular ER docs didn't care enough to look even when I asked and it could have been MUCH worse. PLEASE be seen if it seems excessive. 

KT: Like the worst period of my life, for so many reasons. 

NS: mine at 6w was like this. cramps worse than usual, bleeding heavy, a day longer. feeling down emotionally. 

KLD: My 8.5 week one was worse, I lost a lot of tissue and a week after the initial loss, when I'd almost stopped bleeding, I had another big bleed and lost the tiniest, saddest placenta ever. (I also laid in a supply of zofran and oxy when we saw the ultrasound where the baby was gone, and spent the worst of it in a haze. I recommend that strategy if at all possible.) 

ALB: I miscarried at 6 weeks with no symptoms at all. A check up at 10 weeks showed no heartbeat, growth only to 6 weeks. I had a scheduled D&C, but began to spontaneously bleed that day. They still performed the D&C, which I agreed to, thinking it would shorten my bleeding and let me begin to heal. I didn't realize I would bleed even longer. So sorry for all your losses, reading brings it back, even after 12 years ♥ 

SC: My 6 week mc was crampy, clotty, and long-lasting. I bled (moderately like a period) for about 3 weeks and I tested positive for hcg and felt pregnant for a month after the bleeding started. My 12 week miscarriage (baby measured 9 weeks) was full on labor with short but intense contractions every 15 seconds until my water broke and the baby was born (then I hemorrhaged and things got SERIOUS really quickly. Please do not hesitate to get medical help of the bleeding is really heavy or you get a temperature (I bled through a super maxi pad in less than 5 minutes... If you go through more than one an hour- get help!). Sorry for your losses, everyone! Pregnancyloss.info and misdiagnosedmiscarriage.com are also helpful. 

CS: Mama- whoever you are, I went through one in February. You may email me at acaringpresence at gmail dot com. I was just a day short of 6w. 

MA: Thank you and I'm sorry, K. I have 2 embryos that are implanted but not viable, I'm trying to decide whether to wait for things to end naturally or book a D&C. 

KS: I bled for 3 weeks with my first miscarriage, horrible cramps and heavy period flow bleeding for the first week, medium flow for the 2nd and light during the 3rd. I passed at least 3 clots bigger than a quarter. I also felt very tired and weak. (Not positive of how many weeks). With my 2nd MC at 5 weeks it only lasted a week and there wasn't many sizable clots but fairly heavy bleeding for a few days, turns out I lost a twin, the other survived. 

SM: Ladies, thanks for answering a very sensitive question. This has been very helpful. There has been no information where I've looked. I am nursing my 8 month old son so I also ask if anyone has had an early miscarriage while nursing? Did it affect your milk supply at all? I estimate that I was around 5 weeks with an unplanned pregnancy and I have lost it. As for my milk supply it has dipped some but not enough to upset my baby. 

KL-D: So sorry, M. It's something I wouldn't wish on my worst enemy. Mine were IVF pregnancies, too (sounds like yours are.) ::hugs:: 

MA: Yes they are K, thanks for your info (and hugs). 

HH: I am still nursing my daughter. She will be 2 on the 26th. She nurses 8 times a day still. I did notice a dip, but I normally do before my period begins anyway. It's enough where she notices (wants to nurse longer and more frequent), but it picked right back up. 

I miscarried 8 days ago. My supply was low for about 3 days, like normal. 

SC: Both my miscarriages were while nursing my 1 year old and I didn't notice a significant difference in supply. I was very glad I was still nursing so that I didn't have empty arms after the losses! 

HW: I miscarried at 6-7 weeks. It felt like labor from Friday to Sunday. Normal period amount with some large clots including what looked like a sac (I scooped it out of the toilet). BIG HUGS! There is no right or wrong. Just be gentle with yourself. So sorry. 

ES: I have some thoughts I will be back to share. Barb actually saved my life when I had a cytotec induced, missed miscarriage, at 16 weeks 3 days( baby measured 8wks 3 days upon ultrasound confirmation) more of my thoughts to follow shortly. 

NgM: That was flippin' terrifying, Beth. Oh, I remember it like it was yesterday, too. 

JM: I was nursing 21-month old twins when I had a miscarriage at 13 weeks. I went with a d/c option and it didn't really affect my milk supply. The anesthesiologist suggested I wait 24 hours to nurse my girls. My nurslings were older though and it wasn't an issue to hold them off. When I had a miscarriage at about 5 weeks, it was like a very bad, very long period and I nursed my 1-year old through it with no issues. Many hugs your way ! 

JU-M: I had a D and C several years ago. I was just over 10w, but embryo only measured 6w. I opted for a D and C for several reasons. I had light bleedings/spotting for several days with some minor cramping, but that's all. 

SDC: My 6wk m/c started like a light period, then I passed one large clot (the size of a prune) & I knew I'd miscarried ‘cause I felt my uterus sag like after a birth. I bled for a few more days but it was never as heavy as a period. 

NgM: I can't thank you all enough for y'all's kind sharing. You're so loving and gentle with each other sometimes... my heart just melts at your tenderness. 

SM: I found out at 10 weeks that baby no longer had a heartbeat, and was measuring 8ish weeks. Declined a D&C. Didn't miscarry for another week, with spotting off and on. Once miscarriage started, it was a gush of blood followed by an egg-sized clot and another gush of blood, every 5 minutes or so, for over 7 hours. I was feeling really badly... on the verge of passing out, high heart rate, etc. I ended up in ER, pumped full of fluids, with low blood pressure/high heart rate. Then I ended up needing a D&C anyway, because there was still retained tissue with blood flow. After surgery, I had light bleeding for a few days. 

NgM: I just re-posted Beth’s story

AW: Hugs to the mamas who asked for this info. 

My three were all between 4 and 6 weeks and every one was different. The first was a surprise; I just had a bad backache and when I went to the bathroom I noticed a bit of blood and then a small sac slid out. The second was long and drawn out; I bled and cramped heavily for almost a month before it passed. The third was just like a heavy period that was a little extra long. 

KC: You've gotten plenty of responses, and both of mine were D&C's, so I don't have any info to add, but I wanted to send (((hugs))) to all the mamas who posted on here. It's an awful, sad experience, and I'm so sorry any of you had to go through it, too. 

Thanks to everyone who responded. This is a topic not often spoken of, so I really appreciate you women allowing us to witness your pain for a few moments. Love to everyone.

Monday
Jan162012

What I've Seen Up to Now

In Wherever You Go, There You Are, by Jon Kabat-Zinn, in the chapter entitled “Mt. Analogue,” Kabat-Zinn says: 

“In a way, that’s all any of us do when we teach. As best we can, we show others what we have seen up to now. It’s at best a progress report, a map of our experiences, by no means the absolute truth. And so the adventure unfolds.” 

This is a great way to describe why I write. 

Thought I’d share.

Sunday
Jan152012

Extract This

Sara, of Flutterby Butterfly, wrote a post entitled, “Do You Judge or Support the CSection Mommy?” wherein she says, in (large) part, cesarean moms looking for support online will find: (emphasis Sara’s) 

“Instead of congratulations, you're more likely to get note of sympathy, like you lost someone. You'll be told that it was probably not really not needed. You will be told that the cascade of interventions caused it. You will be told that the epidural was responsible. You will be referred to ICAN and the Unnecessarian (sic). You will be told that maybe next time you can try for a VBAC. You will (be) encouraged to try an HBAC.  If you refer to the c section as a birth, you will be corrected and informed that it was just an extraction. You will be told that your bond with the baby isn't as good as the bond that is created by vaginal birth. You will be told that you should have trusted birth more. 

“If you give your reasons for the c-section, you will be told that whatever it was (pre-eclampsia, nuchal cord, breech, transverse, high blood pressure, twins, big baby) was just a variation of normal. 

“In other words:  The amazing and joyful experience of bringing your child into the world will be torn apart and judged as not good enough.  The wonderful moments of meeting your baby for the first time will torn apart and judged as not good enough.  The reasons that you had a c-section in the first place will be torn apart and judged as not good enough.” 

What Sara says is so true it makes my stomach turn. What the heck is with women that they have to terrorize new moms, making them second (and third and fourth) guess what happened during their labors and births? Why is it so important to make women feel like crap about their births? Who does that serve? Certainly not the healing mother. 

Yet, in the original thread in Facebook, other women said: 

“I experienced the opposite of what this blogger describes. After my c/s, I was depressed, angry, and bitter. I so so wish someone had told me that it was ok to feel this way. Instead, I got the ‘at least you have a healthy baby’ and no one seemed to understand why I felt the way I did. This made me feel even more alone, even more guilty for the poor bonding, and pushed me further into depression. I was ECSTATIC when I found out that there were people that felt the way I did after my c/s and that I wasn't alone or crazy-- I sought them out, not the other way around.” 

and 

… finding (virtual) support at long last, I also learned that my hellish-induced-labor-turned-c-section-and-eleven-days-at-NICU was not a birth. Nothing's perfect in this world, I suppose.” 

What the heck is this “extraction” crap? I suppose I’m not supposed to contradict another woman’s perception of birth, but what Sadist started this “extraction” crap? 

Can I tell you how sorry I feel for the child born of a mother who says she didn’t give birth to the kid? That s/he was “an extraction,” like an infected tooth or a cancerous mole? What is that going to do for his or her self-esteem? Has anyone thought that far ahead yet? What a horrible set-up for loving parenting, starting out thinking your baby was “extracted” from your body. 

Birthing occurs in far more places than the vagina. We birth ideas. We give birth to ourselves as understanding occurs through introspection. We’re reborn when we embrace a new religion. Birth is a beautiful metaphor for many aspects of our lives on earth. Can’t birth via cesarean at least be a metaphor for the beginning of a new life despite the baby not coming via the vagina? 

Women in many places around the world would give their lives to have a cesarean birth… and do, by having vaginal births that kill them. Do you think that women in Somalia have a remote belief that a cesarean isn’t a birth? Puh-lease. What an amazingly arrogant luxury it is for a woman in our culture to pick apart the way/location/method of birth, designating a cesarean as a non-birth when so many women are dying in other regions and countries. And for the women that die, there are many others who would have killed to avoid the trauma of an obstructed vaginal birth. Ask the women who are now non-persons because of their obstetric fistulas whether they believe a cesarean is an “extraction” or not. Or the women who delivered dead babies vaginally when a cesarean would have saved their babies’ lives. 

Quit being dramatic, you Extraction Queens. Find a way to get over your selfish belief your birth wasn’t real because of the location the kid entered the world from. That doesn’t mean mourning a vaginal birth isn’t warranted (if that is your inclination; not all women need to), but it does mean to knock it off about the desire to use shock value to get pity from others.

Enough already.

Friday
Jan132012

Beth's Hemorrhagic Miscarriage

This is a re-post from several years ago, but the topic came up recently on Facebook, so was led to re-post it now. Plus, Beth, the woman in the story, is writing her view of the experience and when she has finished, I will add that to the end of this one. Check back in a few days.

Trigger Warning: Miscarriage discussed in detail as well as a photo of the Products of Conception (POC) at the end of the post. 

I got a call from the glamour sono place 3 days ago. My client, 16 weeks along, had gone in on a whim to see the baby's gender. She brought her best friend and all the kids as well. During the ultrasound, it was apparent there was no heartbeat and, of course, the sonographer couldn't say anything, so she mentioned that the baby actually measured 8 weeks... perhaps she was off on dates? As soon as my client left, the sonographer called me even though she didn't have a prescription from me or anything. I am very grateful for her caring. Immediately I called Beth (she was still driving home) and told her what she already knew. Beth is very calm and quiet, very matter-of-fact, so calling her while she was still on the road wasn't an odd thing to do. For another woman it might have been totally inappropriate. 

I was Beth's midwife for her last baby. She's had 2 hospital births, a UC and then the birth with me. She'd asked me to be her midwife this time, too, so I was very much looking forward to working with her again. 

For another reason, she had to go to the doctor, so sent her to a beautiful, gentle doctor we were just getting to know. Dr. G(entle). I had not done a prenatal on her at all, still, so technically, she was his patient. 

Because she had not had a spontaneous miscarriage and it had been so long since the fetus had died, it was important for her to consider inducing the miscarriage (technically, it is called an abortion, but doesn't mean it in the political sense, merely a medical sense... an SAB - spontaneous abortion). She went to see Dr. G and after another sono verified the demise, mom had labs drawn (to check her iron levels with a Hemoglobin and her HCG [pregnancy hormones], both as baselines) and then filled the prescription for Cytotec ("medically managed miscarriage"). Beth is very aware of the controversy around Cytotec, but for miscarriage, this is an absolutely correct usage for it. Even so, not everyone would prefer this, instead choosing a D&C. Weighing the risks and benefits is really important because D&Cs come with their own set of risks. 

On June 30 at about 7pm, she placed the Cytotec into the os of her cervix. (I didn't know she was putting it in so quickly; I would have recommended she wait until first thing in the morning after a good night's sleep. Note! Inductions of any kind are best done first thing in the morning!) She had no contractions and nothing really happened until about 1:30am on July 1. Then she started bleeding and didn’t seem to stop. Sitting on the toilet, she dropped clot after clot and dripped blood that sounded like she was peeing. She began going through more than a Poise an hour (extra large pad), but thought it was all normal (and very well would have been except it didn’t stop). 

I got a call at 5:17am with Beth saying she felt faint and was getting worried. I jumped out of bed and was out of the house in 11 minutes, the only make-up on was from the day before. I barely combed my hair and poured a Diet Coke in my Big Gulp cup and headed out the door. Being 45 minutes away, I talked to her once I was on the road, asking about the bleeding and she telling me about the clots she could hear plopping into the toilet and the large amount of blood that kept coming out. I asked her to please not get up without help and she said she was going to wait for me. I told her she might have to pee and if she did, please have help. She said, again, she would wait for me. 

Beth was at another client of mine’s home because she has 3 small girls in a little house and knew she would need some help as she began the letting go process. I am so, so glad she was at my other client’s home, a woman who’d caught Beth’s UC baby and was a wonderful and loving best friend. L has two beautiful girls and her husband R was home, too. In fact, when I got to the house, R opened the door, ushering me right to Beth who was on the couch in the living room. I arrived at 6:25am. 

I sat with Beth on the couch, listening to her tell me she felt so dizzy when she got up, but she needed to pee. After a few minutes, I walked with her to the bathroom and she sat, plops of clots and blood gushing into the toilet. The clot that I saw was twice as big as my fist, but it was quickly covered with blood, the toilet looking like only thick blood was in the bowl. Had she been doing this since early in the morning? She said she’d wanted to call me at 3:00am, but thought she should wait longer. I wish she’d have called me earlier! Don’t ever worry about waking a midwife! 

I learned at Casa de Nacimiento (a birth center I trained at in El Paso, Texas) that when women tend to faint, it is often after they pee. The fluid shift in the body might be one reason, but I don’t know the exact technical reasons; I just know that it happened at Casa a lot. My Anglo clients didn’t faint nearly as much as the Hispanic women… don’t know what’s up with that either. 

Beth felt very dizzy, so she rested her head on my thigh for a few minutes. She would pick her head up, then lower it again; we stayed there for about 15 minutes, blood dripping the whole time. Then she took a deep breath and said she could get back to the couch, so she cleaned up a little, pulled up her undies and pj pants and we left the bathroom. She stepped out first and I was sort of behind/beside her and knew I needed to get in front of her. As I was stepping to scoot around her (we were in a hallway), she went down. And went down fucking hard. 

Beth fell as if she were a Sequoia… straight forward, stiff… and right onto her face. Onto a tile floor. Horrified, I fell to her side, touching her gently as she twitched in the way women who faint do. R came to be with us, too. L and the kids were still asleep. I spoke softly to Beth, telling her she wasn’t alone (I know that many people who faint lift out of their bodies and can see and hear what is happening even though they can’t respond) and apologizing for not catching her as she fell to the floor. Today, Beth said that was the first thing she remembers after the bathroom, my telling her, “I’m so sorry I didn’t catch you!” As she got back into her body and could talk, she said her face hurt. Her lips swelled immediately, her top lip nearly touching her nose. Later we were able to joke that women could naturally plump their lips simply by falling on them each morning. Who needs those pesky bee sting injections? 

Beth fainted at 7:15am didn’t move from her exact same position for over 45 minutes. L woke up and we all sat on the floor next to her, talking with her about how she was feeling and what I felt we needed to do. Right after L woke up, I grabbed my phone and called Dr. G, relaying the events to him. I told him I thought we should come in and he shared with me what would happen if we went into the ER… fluids, a sono and if there were still POC, she would need the D&C. He said that he felt the worst was over and asked how much she was bleeding. We took her pants off, put a Chux under her and there was very little bleeding. He asked for her BP and I didn’t leave her to grab the cuff right when she fell, but took the few seconds to get it and took her BP… wrong. She was face down, upside down to my usual orientation, and I put the cuff on upside down. Rolling my eyes, I re-placed it, taking her BP and it was 80/40… a re-take a few minutes later was 90/50, so it was coming up. I asked Dr. G if he felt a shot of pit might be called for. He said the Cytotec worked in much the same way, but it couldn’t hurt. I had an instinct that it would help, but think that’s because of my limited ability to attend to hemorrhage in the home setting. The doctor said he still felt comfortable with her remaining home as long as I stayed with her and if there were changes, we would go in. After hanging up, I went and got a pit out of the car along with some homeopathics (after talking to another midwife who is far more skilled than I in homeopathy). I gave her the shot of pit in her left upper arm. L got Beth some arnica and gave that to her as soon as we thought of it. 

Beth loved lying on the cool floor. We also got ice packs and put them on her bare back, her neck and gave her ice chips as well as sips of water. After that first 45 minutes, we turned Beth over to her back (it was horrible see the whole damage of her lips and teeth!), getting her a pillow and then really encouraging her to drink water to increase her fluids. L also got her a Popsicle to suck on to help quell the swelling. Any thought of sitting up was squashed as she said she knew she would faint if she did. One of L’s daughters woke up and casually asked, “Why does Miss Beth have no pants on?” We said she wasn’t feeling well and was hot, so didn’t want any covers. 

Once Beth was on her back, she rested for quite awhile longer. I checked her uterus and it was very firm and easily felt. When I talked to Dr. G, he suggested that perhaps some tissue was still in the uterus or in the os of the cervix and uterine massage would be a great idea to move the tissue along. While initially, it didn’t seem there was any bleeding, slowly, I could see blood seeping through the Chux pad. The doctor also said some bimanual compression would be necessary if she started hemorrhaging badly, but we never got to that point. 

Beth began getting cold, so L found a Nemo towel (she asked for Scooby-Doo, but L and I scoffed… nothing but Disney; it really was the only choice) and we covered her with it. She really liked my massaging her uterus. When I had to step away, she did it herself. It seemed the uterus was always firm, but there was one side that got boggier and needed massage. We talked about my calling 911, but if the ambulance came to take her, they would take her to the only hospital in the county that all of us despise. This was the hospital where my client was abused and I turned them in to JCAHO – and ever since, they won’t let me past the front desk, even when transporting my own clients. Beth refused to go to this hospital, so we talked about how to get her to the hospital. She said she was feeling better, but still didn’t think she could get to the bed that was about 10 feet away. R said he would carry her there, so she put her arms around his neck and he lifted her, straight off the floor and carried her to the bed L had gotten ready with Chux and clean sheets. Beth melted into the bed. She said it was much more comfortable than the tile floor. 

I gave Beth some Nat Mur for the bleeding (I didn’t have anything else the midwife recommended) and Arnica 200 for her swelling. We did a couple three doses altogether. She had to go to the bathroom and getting up was out of the question, so I told her to just go on the Chux, but she couldn’t so B got her a Pull-Up and she easily peed into that. Beth was lying on L’s youngest daughter’s bed and L said it had great pee karma, so she shouldn’t have any trouble going; she didn’t. Maybe urinating would help keep the uterus firm? 

Beth felt so much better in the bed. Perhaps the bleeding really was done. Dr. G called again and said it can be so hard, the Cytotec/miscarriage experience, that sometimes it’s such a storm and he was sorry she’d been experiencing that aspect. Certainly the storm had blown itself out. 

With Beth resting, I told L I was going to sit in my car in the driveway and try to nap for a few minutes, but I would be back in shortly to check on her. L stayed with her. About five minutes after I got into the car, L came out and said Beth was sweating. I dashed in and knew then she was absolutely going into shock. I called Dr. G to let him know we were on our way in and he said he would call the ER to let them know we were heading in. 

R had left for work a few minutes earlier, so L called him back and while we waited, L got the van ready to hold Beth in the back row, still lying down. Any lifting of her head brought her complete dizziness and an urge to faint. R came in and lifted Beth easily and put her in the back of the van, feet raised and she was put in charge of massaging her own uterus, not only to keep it firm, but also to give her something to do, focus on something other than how poorly she was feeling. 

I followed L and instructed her that if Beth needed help, to pull over and I would call 911 immediately. Blessedly, even though it was 9:00am, the traffic heading south wasn’t bad at all. 

We got to the hospital Emergency Room parking lot and I calmly (but quickly) went in to get a gurney for Beth. I had to wait for the nurse fill out the paper wait for the nurse again tell her she can’t go in a wheelchair she can’t sit up she needs a gurney… “Let me go talk to my supervisor” oh, hello supervisor, oh, the gurney won’t fit here how about we move the van so the gurney can get next to the van where is everyone why don’t they frickin’ hurry UP already oh, move the van how clever of you. L moved the van to where the ambulances drive up and then Beth slid out of the van on her butt and rolled onto the gurney. I breathed a huge sigh of relief that we were at the hospital. Writing this, it brings tears to my eyes. The two hours of worry and concern… and heightened awareness… were over… at least with regards to my personal responsibility. 

Monitors were attached, the blood pressure cuff attached and the pulse oxymeter all attached within seconds of getting to the curtained off section we would be assigned to for the next 12 hours. Blood was drawn and the IV started, even before the nurse got orders to do so. Over and over, Beth, L and I would sigh deeply and say, “I’m so glad we’re here.” Sometimes the hospital is a wondrous place to be. 

Know that things were done very quickly –for an emergency room. Beth had a sono and a CT scan, the ER doc was an angel, asking me what I thought about a D&C, saying he didn’t want to counter her HCP. I was flabbergasted. Oh, and the nurse knew who I was… had looked over my website and wanted to be a CNM but didn’t know how to get there. I gave her my card and she promised to email me. 

Dr. G came in, cancelling his afternoon so he could spend it with Beth, looking at the sono results which showed something in the os of the cervix, so he was going to do an exam to see what he could find. The CT scan’s results came later and were normal. (She had the scan because she smacked her head so hard on the floor.) The blood work came back showing that her hemoglobin had gone from a 12.7 to a 10… not really horrid, actually. The doctor wanted to re-check her Hgb after the vaginal exam to see if it continued dropping. 

Dr. G came in with “drumsticks” – long, long cotton swabs, gloves and a nurse to assist. Within moments of the exam, it became apparent why Beth had been hemorrhaging. The POC had gotten trapped between the uterus and the vagina, lodging itself in the os, not allowing the uterus to clamp down on the “open wound” area the delivering placenta left inside. It didn’t take five minutes to relieve Beth’s body of the baby that seemed to linger inside. Whereas we thought her uterus had been clamping down before, after the POC was removed, it was a distinct difference, how low the uterus shifted and how firm it finally stayed. There still was some bleeding, but not anything like there had been, so the doctor talked about rectal Cytotec which made Beth shudder. We both explained that rectal Cytotec is used for hemorrhaging and since she’d had several babies, it might not be a bad idea to stop all the inappropriate bleeding. Beth very much wanted to avoid the Cytotec. Later, she began taking methergine, the other medication many midwives carry, along with Pitocin. We give methergine to women who might have retained membranes, so this seemed like a good idea. 

Another sono showed the uterus, os and vagina were empty. The miscarriage was complete. 

It became apparent that she was going to spend the night. They offered to let her go if her Hgb wasn’t much lower (it was lower), but Beth really felt she needed to stay. For a former UCer to say she needed to stay in the hospital, they best listen to her! 

All the major drama and work completed and the waiting for a bed begun, I excused myself about 2pm and went home to nap; I am on call for a term mama and definitely needed to rest up a little. It won’t surprise birth workers, but I wasn’t the least bit yawn-y when with Beth until things started to wind down. In the moment, I felt unlimited energy, no pain in my feet and completely present. As I drove home, however, I was groggy and couldn’t wait to climb inbetween my bamboo sheets. 

Beth got a bed about 12 hours after entering the ER. L stayed with her the whole time, feeding her ice chips and juices now that the possibility of surgery had vanished. I learned the next morning why she wasn’t eating food; her teeth’s re-positioning didn’t allow her to chew, her molars unable to meet because of the way her front teeth had moved around. I continue to feel just horrid about her falling face down. I wish I could re-play that moment (I would step out of the bathroom ahead of her) or fix her teeth as easily as I can measure dilation. 

I went to see Beth the morning after and her Hgb was now 6. She accepted the offer to receive two pints of blood (A Positive, just like me). Dr. G said she didn’t have to have the blood, but after L’s hemorrhage (after her last birth), she saw how it took three months for her to get back on her feet and knew she couldn’t take that long with three young girls. She said if she hadn’t seen L’s recovery without a blood transfusion, she would have refused. Seeing it, however, she knew it was the best choice for her. Each bag takes about three hours to drip in and I was there for ¾ of the first bag. When I walked into the room, she was the color of the sheets. By the time I left 2 hours later, she had some color in her cheeks and already felt much better. After both bags, she felt like a new woman. 

Walking in, there was a sono machine and tech next to Beth’s bed. She was getting a heart ultrasound to make sure there were no misfirings that caused her fainting. I yacked with Beth as we watched and listened to her heartbeat on the monitor. 

After the really long sono, she had to go to the bathroom and was doing that at a bedside toilet. She’d gotten up twice to sit on the toilet, always with someone present, and didn’t faint sitting up for a couple of minutes each time. 

While the sono tech was still there, another woman came in and stood to the side. She was a Physician’s Assistant (PA) for the cardiologist who ordered the ultrasound. I asked her to please wait until Beth went to the bathroom and she stepped out. 

Sitting the bed up a little, Beth slid out of the bed and sat on the toilet, peeing tons (the heck if she was going to get swollen from those IVs!). While she was on the toilet, I straightened her wrinkly, unruly sheets and blankets, including the ever-present Nemo towel. I needed more Chux and the PA brought me giant diapers instead, I putting her back in bed, tucking the Chux under her once they delivered them. 

I was only there two hours and 100 annoying things occurred. The sono tech dislodged Beth’s IV and I had to grab the nurse to fix it, but not before blood gooshed all over the blankets and sheets. The bed across from her was empty, but the phone rang as the person on the other end looked for the former occupant. A nurse asked her what she could do for her and when Beth asked for grape juice, the nurse said they didn’t have any… “We have apple juice…” “Um, they’ve been bringing me grape juice all morning.” A nurse’s tech went to get some for her and I followed with her pitcher to get her some ice and even more juice. The tech returned with two grape juices and a small cup of ice. I trumped him with two more juices and the pitcher of ice. Ha! She’d explained she needed a soft diet, but no one put that in to food services. I don’t know if it finally happened, but L was bringing in soft food for Beth to chew. A nurse came in to take vitals. 

And then the PA came in during the cacophony of medical visitors. She asked 100 questions about Beth’s medical history and then when we got to the part about her fainting, she asked me what it looked like. I told her how she fell (groan) and how she had those typical jerky movements of someone who faints. Her ears perked up and she said, “Like seizures?” Um… not really, but you could say it looked a little like that. She bit on that concept like a pit bull on a beef bone. I repeated that it wasn’t a seizure, per se and finally settled on the word “twitching.” She matter-of-factly said, “We’re going to move you up to the cardiac floor so we can put a heart monitor on you until you leave and then we’ll send you home with a holter monitor that you’ll wear for twenty days and then come back so we can determine if your heart was the reason for fainting. Beth kind of sat there for a second and I said, way too loud, “Um… how do you FEEL about that Beth?” and she said, “I think it’s stupid.” (I think she really said, “I think that’s overkill,” but she really meant the stupid comment.) The PA was taken aback. In her gentle way, Beth refused the visit to the Cardiologist and even the move up to the Cardiology wing. The PA wished her well and left. Beth and I laughed our heads off about that until her (new) nurse came cheerfully in saying, “Okay! We’re going to move you now up to Cardiology…” and Beth said, “I’m not going.” The nurse was totally taken aback and a back and forth, “But you have to,” “But I don’t want to” went between the two. The nurse saying, “We need the bed” as if that was going to convince her. Beth pointed to the empty bed across the room and said, “They can have that one.” I said, “Maybe you want to talk to the Nursing Supervisor?” and the nurse kind of huffed out. Again, we laughed, but were a bit peeved that she ignored the supervisor comment. About 15 minutes later, she came in and said the Nursing Supervisor said she didn’t have to move. Beth said, “I wasn’t going.” 

During all of this we talked about all the meds she was on and I chuckled saying she’s probably taken more meds in the last two days than she has combined in the last 15 years! She said that was surely the truth. She also had a running list of firsts for her: fainting, blood transfusion, IV antibiotics and more. 

During the day, she finally stood and walked, walking around the whole floor before she left. About 7pm last night, 36 hours after entering the hospital, Beth was released, but only after Dr. G called the Cardiologist who wasn’t going to release her because she was being non-compliant! He finally did and she left, going to L and R’s house again to recuperate and be taken care of. I got the greatest text that said, “I‘m gonna make you proud at how much nothing I will be doing.” 

So, amidst all this drama and trauma, we’d barely touched the issue of losing the baby. Every once in awhile I would ask how she was doing and she would always say, “Okay.” Last night, I texted her that as things got quieter, she would probably find herself feeling more and to let the emotions wash over her, for the miscarriage and the hospital stay… and reminded her that women who hemorrhage have a tendency to be sadder than usual as the hormones of un-pregnancy find their balance. She said she would be gentle on herself and would call me anytime she needed to talk. 

I’m glad she’s resting and being lovingly taken care of… she deserves it at this challenging time. 

Twice during the experience, I was told, “You saved her.” I didn’t really think about that, but if I did, I’m glad and also know it is all a part of my calling as a midwife. It didn’t feel heroic, but apparently it was a really good thing, my going to help and getting her more help. I’m just glad my friend is still here.

Sunday
Jan082012

Mingling

After I wrote “Hiatus,” I really delved into why it’s fairly easy for me to yack and share my thoughts in Facebook, but it had become so hard to do here. What I came up with was interesting. 

In Facebook, I feel like I’m mingling at a party, moving from person to person or even group to group (depending on how many people are participating), talking informally to each one. Not being more important than anyone else, each person’s opinion heard and validated. I can be humorous, snarky, sympathetic and respectful there in a way that mimics me in real life. 

However, here on the blog, I feel like I’m standing behind a podium, speaking to an audience and what I say better be earth-shattering… or at least good. That feeling has gotten uncomfortable and I’ve felt stilted and stifled in sharing who I am, the original purpose of the blog. 

So, I’ve decided to go back to the reason I started writing in the first place… to share ideas, to discuss them and to have a good time with my writing. I’m going to write more like Facebook and hope others will participate like the women do over in that corner of the Net. 

We’ll see if the mental removal of the dais helps the words flow better.

Saturday
Jan072012

What a Doula Said

On my Facebook Page, I dropped a link to this piece, “Journal Article Review – Bipedalism and Parturition: An Evolutionary Imperative for Cesarean Delivery?”, an article about (just what it says) walking around on two legs and does that fact make it more likely that we’d eventually need to deliver our babies (at least more of them) by cesarean section. It’s an awesome piece and the comments have, for the most part, been great… Creationists aside. Well, their comments are interesting. Hard to believe people still think like this, but who am I to poo poo another person’s religion. 

Anyway. 

Along the thread comes this doula who says, and I quote verbatim: 

This is the most insidious article I have ever read and it figures that it was written by a man with a penis who will never experience childbirth. Fact: only 3% of women in the US actually need a Ceasarean due to try complications. In most cases they are performed out of laziness and impatience on the hospitals and docs part. And insurance companies, lest we not forget those bureaucratic jackasses.” 

I couldn’t help laughing outloud, but what I wrote was: 

Where did you come up with only 3% of women need a cesarean? I have NEVER seen that number in 30 years of birth work. Source, please.” 

And this was her answer, again quoted verbatim: 

I got the stat in an article I just read, I will find it and repost. In my experience with my clients he need for C/S deliveries is 0 with home births and about 2% for hospital deliveries. The procedure has skyrocketed unneccisarliy.” 

My short answer to that was: 

So, <Doula’s Name>, how many births have you been to? 4? Talk to me when you've been to the 900 or so I have, then we'll see what "your" cesarean rate is. 

You have a LOT to learn, young lady. Your arrogance is going to bite you in the ass and I hope you will then learn some humility. 

And quoting ONE FREAKIN' ARTICLE that said the c/s rate shouldn't be above 3% is the height of gullibility. Do you not know discernment? It scares me there are doulas like you out there.” 

What is this doula teaching her clients? What is she saying to women all around her? Spouting off her amazing statistics without so much as any qualification of how she got to that number. 

I started thinking, “How could I get a 0% c/s rate at home and a 2% for hospital births?” 

  • I could have only attended 5 births.
  • I could take only clients that have had babies born vaginally before and are truly low-risk in this pregnancy.
  • I could lie about my statistics. 

There are so many parts to her comments that annoy me, it’s hard to just pick out a couple. But, I’ll try. 

  • If we are to believe she’s been to at least 100-200 births to even get a somewhat valid number, “her” 2% hospital birth cesarean rate is incredible considering the cesarean rate in hospitals. Is she so magical that when she is there her clients miraculously avoid the operating room? If she is that magical, she should be teaching courses all over the world so the rest of us can know her secrets. 
  • If you throw out the word “Fact,” you better have a buttload more than one article to point to and, at the very least, one you can put your finger on at a second’s notice. That she even had to look for it stuns me. 

Note to doulas and other birth workers: Just because you want it so badly you can taste it, doesn’t make it so. If you repeat crap others say, even others who proclaim they are (or who are heralded as) experts in birth, you best be able to back up your beliefs. Sure, statistics can be skewed, but looking deeply into anything touted as real and true will probably give you a much clearer picture of what you’re talking about. 

No one… NO ONE… in this community has The Answer. If she did, it would be headline news.

Friday
Jan062012

Rapunzel

It seems a few of us are watching Disney’s version of the Rapunzel story, Tangled, and one of my birthy friends chuckled about the Queen’s life being saved by herbs. Well, it’s not quite as simple as Disney makes the story out to be. Having loved the Rapunzel story as a kid and teen, I leapt at the chance to put a midwifery spin on the very old Grimm Fairy Tale. I’ll share it with you, too. 

Once upon a time, there was an old couple who ached to have a baby, but the woman couldn’t keep a pregnancy and despaired of ever having a child. When she miraculously got pregnant, she wanted to do everything in her power to keep the pregnancy growing so she could have the much-desired baby. 

Now, this was the olden days where, in many places (if not most), pregnancy was a challenge even with those that had money and means. For the poor, pregnancy all too often meant death, so all sorts of Old Wives’ Tales and superstitions came about and one of the most common was that when a pregnant woman craved something, she was to be indulged, no matter the cost. It wasn’t unheard of for complete strangers to give a wandering pregnant woman their best meat or a glass of cherished wine; anything to help the baby inside come to fruition. In some cultures, it was even okay to steal food if the pregnant woman testified it was for her, no charges brought against the offender. 

It’s in this setting that the older pregnant woman began having cravings, specifically, cravings for the rapunzel plant, a very leafy green, spinach-like plant. Her cravings, unmet, made her very ill. Was she anemic? Did she need the iron in the rapunzel plant? 

The distraught husband tried to find his wife’s desire, but no one could grow any in their gardens, nor knew where to find it. But, there was that farm next door and that amazing gardener, Gothel… and lo and behold, she had the rapunzel plants growing like weeds just over the fence from the old couple. When the pregnant woman spied it, she begged her husband to please get her the leaves. Gothel was a total bitch, er… witch… and the husband despaired, knowing the crotchety gardener wouldn’t ever share anything, even for a pregnant woman.

Therefore, the husband knew what he had to do. He had to sneak over the fence and grab the rapunzel leaves for his wife. Dangerous? You bet, but if he didn’t, the baby… and mother… were surely going to die. 

When there was no moon, the old man snuck across the fence and grabbed a few leaves for his wife. Upon eating even those few, she grew much stronger. (Ah, it was anemia!) But, any time she didn’t have rapunzel leaves at a meal, she grew weak again, so her man had to keep sneaking over the fence for his wife and child. He did great… until the full moon. 

As he crossed the fence on that fateful night, Gothel grabbed him and demanded to know why he was stealing from her precious garden. When he explained the dire need of the rapunzel leaves for his wife, Gothel seemed to soften a bit. Wondering why he didn’t just go ask in the first place, the husband let his guard down as the witch cheerily said he could have all he wanted. She would put it in baskets for him so he wouldn’t have to sneak at night anymore. He was so relieved! 

Then, Gothel struck her bargain. 

Yes, the woman would be able to save herself and her child with the plant, but the baby would have to be given to Gothel in exchange. Certainly, because the baby was a nebulous unknown and his wife was a living, breathing being to him, the husband/father-to-be thought for merely a moment before agreeing to the deal. He probably should have consulted with his wife, but she was busy gestating and eating salad. 

True to her word, Gothel supplied the couple with copious baskets of rapunzel and the wife was ecstatic, thinking the neighbor wasn’t a crazy old loon like they’d thought she was. Scared, her husband neglected to explain why so much lettuce was being foisted over the fence. 

(We can imagine) The baby’s birth was awesome! The midwife was extremely educated and had tons of experience, had a long line of three generations alive and well before she came to the old woman’s bedside to help the baby be born. The elderly primip, pumped up to the gills with iron and love, was the picture of health during labor and didn’t even tear a tiny bit when the beautiful baby girl was born. 

As the mom reached down to pull her new baby to her breast, Gothel appeared and demanded payment for all that rapunzel. Horrified, the mother screamed… the new father begged Gothel to reconsider… he now saw his daughter as real, not so ethereal anymore. Gothel, the bitch that she was, snatched the newborn away from the midwife and took her back to her farm. 

I can imagine the mom had a helacious case of postpartum depression over this and probably demanded a divorce, but we never hear from them again in the story, so I’m kind of at a loss as to find a happy ending for them. 

Gothel, on the other hand, loved being a mother. She doted on the baby, then toddler, then child, flaunting her in the garden, within clear eyesight of her parents. Year after year passed and the baby, now named Rapunzel (after the plant that kept her alive, of course), was the most beautiful girl in the entire world and she had amazingly gorgeous blonde hair that grew and grew and grew. 

Rapunzel had another talent besides growing hair; she could sing like a bird! All day and night, the child sang so beautifully, all who heard her marveled at its beauty. 

Knowing that Rapunzel would one day want to leave her, Gothel couldn’t abide by that and built a tower with no doors and one window, building it around Rapunzel when she was 12 years old. Menarche. (What did the tower represent? A phallus, surely. So it seems Gothel’s goal was to seclude Rapunzel from all phalluses except for the one she built for her child.) 

Rapunzel had amazingly long hair, so when Gothel came to her each day, she would cry up to the girl: 

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair.” 

 And the girl would first toss her hair up onto a hook and then let it down to the ground far below. Gothel would wrap the hair like a sling, step into it and Rapunzel would hike her up, bringing her into the only entrance into the tower. 

Stuck inside the tower, Rapunzel’s main entertainment was her own singing. She sang all the time, the animals enthralled with the beautiful melodies. 

Then, when she was 16-years old, singing her heart out, a Prince road near and heard the amazing songs. He sat near the tower, imagining the beautiful girl whose voice moved him to tears. Each day, he came to listen to Rapunzel sing, not seeing a way into the tower to witness her performances. 

One day, however, he got there early enough and watched as Gothel called out, 

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair.” 

Rapunzel’s hair fell to the ground and the old woman was lifted into the tower. “Aha!” thought the Prince. He now knew how to get in to see the singing beauty. 

He watched for a number of days and saw that Gothel only came in the morning and left before dark, so one night, right after the sun set, the Prince went to the tower and cried out,

“Rapunzel, Rapunzel, let down your hair, so that I may climb the golden stair!” 

On cue, the hair unfolded down to the ground. The Prince followed what Gothel had done and was soon aloft, getting closer to the woman he surely loved. 

After Rapunzel got over the initial shock of having company, she quickly fell in love with the Prince, singing for him as often as he asked her. 

During his nightly visits, they also began having sex as their hormones were a’raging, both being 16 and all. The planned Rapunzel’s escape and each night, the Prince would bring a swath of silk for his love to braid into a ladder for her to flee from her captor. Rapunzel was very careful to hide the silken rope so Gothel would not see it. However, instead of finding it, during one absent-minded day, Rapunzel asked the witch, “Why is it you weigh so much more than the Prince when he comes at night?” Oh, no! She gave away her secret! 

The crazy-with-anger Gothel tied up Rapunzel until that night when the Prince came. The witch used  the flowing hair to lift the Prince and when he made it just inside the window, the witch immediately, with great force, threw him back out, his landing face-first into the thorny bushes below, blinding him, thereby forbidding his ever seeing his beloved Rapunzel again. 

The young girl wasn’t out of the woods herself. The witch was livid, so banished Rapunzel into the wilderness. What the old woman didn’t know was Rapunzel was already pregnant, with twins, and as she wandered, her belly grew and grew. Still singing, she gave birth to her babies (an unassisted birth, apparently) and wandered in the deserted land with her son and daughter. 

When the Prince was blinded, he could no longer find his way home, so he, too, wandered all over the land, unable to find anyone to help him. Then, one day, he heard his precious Rapunzel’s singing voice and followed it from whence it came.

When they were reunited, it was a glorious day! The Prince felt his lover up and marveled that he had two children. Rapunzel was so sorry she’d put the Prince into the situation where he was blinded that, embracing him, she cried sad tears of intense love and begging for forgiveness. As the tears fell into the Prince’s eyes, they were so pure, his eyesight was restored. 

The Prince could then find his way home and the Kingdom rejoiced their Prince had come home… and with a wife and kids to boot. 

And they lived happily ever after, especially knowing that Gothel, stuck in the tower without Rapunzel’s hair, was going to die a lonely and miserable death.

Tuesday
Jan032012

Hiatus

Not that this is news to anyone who reads here regularly, but I’m going to take a formal break for awhile… not sure how long at this point, but the worry over not writing, especially not writing blog posts on the blogs, causes much distress as I work to heal from this intense depression. 

If something pops up here or there, cool! I might even toss up some pics of the granddaughter, but no commitment of posting anything until… who knows when. 

Until then, I’ll be working on my Dialectical Behavior Therapy (pardon the Wiki link, but they have a great, easy-to-read, explanation of DBT) individually and in groups. I might not be writing here, but I will, most assuredly, will be working hard - on healing.

One of my meditation focuses.

Thursday
Dec012011

Meghann Nursing

L: Meghann, 2.5 years old, "nursing" Fern.
R: Meghann, 27 years old, nursing 9-day old Gabriella. 
Sunday
Nov272011

Bouncing Atoms

So, I was trying to read this morning, but couldn’t keep my mind on the words and was grabbing the computer to head into Facebook, but thought perhaps I should try to quiet my mind and grabbed my phone instead.

I’ve downloaded a couple of cool apps that allow me to set a timer with a woo bell so I can focus my breathing anywhere. (I’m having a really hard time calling it meditating… just seems too woo woo for me right now.) I set the timer and put my hand on my belly and then, for four minutes, I proceeded to not pay attention to my breathing. Instead, my thoughts bounced around like heated atoms in a pan of boiling water.

I kept thinking I wasn’t breathing right. The timer was winding down. Usher the thoughts out gently. No judgment. Why did my son send me an apology? What did he do? Don’t worry… usher the thought out. No judgment. Did he break something? The time is winding down. Breath. Breath. Feel the breath. Breathe deeply. Maybe I should have focused on something instead of my breath. The elephant, maybe. Maybe the origami bird? I need to learn how to focus on my breath though. I do take it with me everywhere. Can’t carry the elephant everywhere. Stop thinking! Usher the thoughts out. Shove the damn things out. Out, thoughts! Is the bell going to ring? I’m spending four minutes without being mindful. I’m going to have to do this all over again.

The woo bell chimes.

For crying in a bucket. That sucked. 

My meditation elephant.

Thursday
Nov242011

Tokophobia Comment

This came across the wires today, a comment to my very old post entitled "Helen Mirren & Tokophobia" (October 31, 2007). Tokophobia is the fear of childbirth.

It's good to hear the voices of other women, especially when they speak of things so out of our realm of reality it's shocking to realize they even walk beside us on the earth. This woman's words are so foreign to me, I can barely relate to her expressions of fear and hate. But, she's speaking about birth, so I am listening to her with an open heart... which goes out to her completely.

M says:

I've had tokophobia for years. But i stumbled upon this article just days ago. I'm 24 now. I've always kept it to myself, cause in my society if people knew, i would be shunned. The idea here is... as a woman, God intended chilbirth to be very very excrutiatingly painful as a punishment, and it is something we have to endure... if we don't, we are less of a woman.

I've had horrid nightmares, some where i have been in labour, screaming in agony, tearing, bleeding, defecating, my vagina being ripped to pieces... and so on. And some where i could see or hear screams of other women giving birth.

I can't even bear being around pregnant women, it sickens me to death. If people talk about anything to do with the whole birthing experience, i have to walk out, or i would throw up.

I cry every night because of my fears. And i cry myself to sleep. Even though i myself am not going through it yet, i feel such enormous pity for millions of women who have to. And thinking about how cruel nature is makes me want to commit suicide. I have contemplated it many times already.

I realised something was really wrong a few years into my phobia, and confided in a very close friend of mine. But she just dismissed my fears, saying i have to bucker up and be a woman, endure what has to be endured, as nature intended.

Don't know why many people are sympathetic of other phobias, when something so dreadful is just not accepted.

I wish everyday i was a man, they have to go through not an ounce of pain, just pleasure to have a baby. U ask any man and he will tell u that one of the main reasons he is proud to be male is this.

I fell and continue to fall deeper and deeper into depression.

And also let me say, what is the point of a mother going through such terror, when a child ultimately loves u for how u treat them as kids, teenagers, and adults.

I've started falling really ill because of my mental trauma. I have a very high fever as i write this.

But i finally feel like there are others out there. Its some sort of comfort. And i THANKYOU, the author and all you readers for your comments.

People talk about curing this phobia. And yes initially even i hoped and prayed i would get cured. It just got worse.

But the truth is Most people dont want to accept it. The say... just face your fear and go through with it. It's like they Want u to suffer... as women should. Rather than easing the pain.

We are such a tehnologically advanced species. And yet (as someone said earlier) childbirth is so primitive, disgusting and unevolved. If it were any other disease, a wound or ailment, painkillers are given, and the patient's needs are of high importance. And yet when it comes to childbirth, people feel it has to be as painful as possible... and no one cares about the mother who's going through, what i can describe as worse than burning in hell... everyone just cares about the stupid baby, who doesn't even have the slightest idea of what is going on.  (again as someone mentioned in a comment). It is very misogynistic and makes absolutely no sense to me.

Tuesday
Nov222011

Guest Post: Max's Birth Story

A dear NetFriend sent me her amazing hospital natural birth story and since she doesn't have a blog and I do, I get to share it with everyone here. Lucky us!

Slightly edited for clarity (with permission) and names and initials have been changed for anonymity.

"Oh, He Doesn't Do That"

As is the case with so many birth stories, the events that defined Max’s story were set in motion months before his actual birth day. Max was my 9th baby. My eighth pregnancy had been awful. Hyperemesis Gravidarum requiring a PICC line, Zofran pump and home health care. A week-long stay in Telemetry, Gestational Hypertension and a week-long NICU stay. When all was said and done, I ended up with a healthy child but it was a long, miserable, emotionally and physically difficult pregnancy and recovery. One of my greatest supports had been my OB. Through it all, he was there. He was actively engaged the whole pregnancy, always listening, always advocating, always caring. So obviously, the first thing I did when I got the second line in Oct 2009 was call his office for an ASAP appointment.

“Hello, I need a new OB appt with Dr. M.”

“I’m sorry, he’s deployed. Can I make you an appointment with another one of our physicians?”

“DEPLOYED! WHAT? He can’t be!! I need him!”

I immediately felt awful. Here was my doc, deployed to Iraq and I was being all selfish and worried about myself. I felt even worse when I found out later that his son was also deployed. His poor wife!

I asked for an appointment with one of his partners, a woman who is lauded as the grand dame of natural childbirth in our area. She used to do home births, will go to extremes to avoid C-sections. Doulas and patients love her. I didn’t. It was apparent by 10 weeks that we weren’t going to be able to work together. I saw her long enough to get prescriptions to manage the nausea and vomiting, which thankfully wasn’t Hyperemesis this time around, and then went looking for another provider.

I went to interview the one group of hospital-based CNM’s in our area. I was hoping I would like them, and I did. Unfortunately, they didn’t like my history. After the three of them discussed it, they decided that I was too high risk and out of their scope of practice. I was devastated. I was so looking forward to midwifery care again. They referred me to an OB in their practice.

“He’s a great guy. You’ll love him.” I was told. At this point I was 16 weeks and just wanted to get a care provider and move on. I felt totally defeated. Whatever, fine, I’ll make an appt. I diddled around on the Internet and found a few reviews of him, they were glowing but there didn’t seem to be a lot of ‘noise’ about him. Not like the woman OB I had left behind. Her name is everywhere.

I started seeing Dr. K for what ended up being a very vanilla pregnancy. He was a great guy and we did get along very well. We talked a lot about my kids, his grandkids, politics, etc. After all, this wasn’t my first rodeo; I didn’t have a lot of questions and didn’t need a whole lot of patient education. Sometimes we talked ‘shop’. Me, being a woman who has immersed herself, literally, as a mother of 9 and figuratively, as a doula, childbirth educator and parenting educator in birth for almost 18 years and him as an OB. The NIH VBAC Conference occurred during that pregnancy and we talked about that and quite frequently about other birth issues.

I never sat down with him and listed what I wanted/didn’t want/believed in/liked etc. We never did a birth plan. We just chatted. He would leave me with little gems like, “A lot of my colleagues practice fear-based medicine, not evidence-based medicine.” And, “I just try and respect the mother.” And, “You know what you are doing. You listen to your body. I listen to you.” This let me know that for the most part we were on the same page.

Not surprisingly, my blood pressure started creeping up in the late second trimester. Nothing scary, just worth watching and it quietly crept up and up week after week. I reached 38 weeks and started getting nervous. I had endured one pre-eclampsia labor with magnesium sulfate and really, really didn’t want to do it again. With that baby I had gone from fine to extremely sick over a weekend. I knew how fast I could go downhill. Dr K wasn’t concerned but respected the fact that I was. At my request, he checked my cervix and I was 2-3/80%/0 station. He agreed to induce me that Friday which would be 38w5d. It took some finagling but I was ready.

Friday morning I showed up at the hospital. He hadn’t booked me in; I was supposed to come in and tell them my blood pressure (BP) was up and get a preeclampsia work up and then he’d just decide to keep me and have the baby.

Well, my admitting BP was 160 (something) over 90 (something) and didn’t come down much with rest. Oh, and I do not have white coat hypertension. The whole pregnancy my BP had been lower at office visits than at home. Think the 8 kids at home could have had anything to do with that? The bogus preeclampsia workup became a necessary one. I think Dr. K was a little surprised to be honest. My blood work and urine was fine, so no Magnesium Sulfate but I was definitely having this baby.

I was admitted, installed in a labor and delivery room and my GBS antibiotics started. During the initial admission questions I told them I was allergic to iodine so make sure he doesn’t use a betadine perineal wash. I was told, “Oh, you have Dr. K, he doesn’t do perineal washes.”

Dh (Dear Husband) and I just hung out and watched a little TV, talked and walked the halls for a few hours. They wanted two full doses of the antibiotics in before (they did) Artificial Rupture of Membranes; we had at least a solid 4 hours of waiting. We got to the hospital at 9am; they didn’t start the antibiotics until noon. So far it was a long boring day. Finally, at 4:30 the two doses were in and here comes Dr. K to break my water. He breaks it, watches the baby on the monitor for a minute and then says he’ll see me later and leaves. The nurse takes me off the monitor (??) and tells me to go do whatever I want and let her know if I start contracting. I was a little confused.

“Oh, continuous monitoring? He doesn’t do that.”

I was confused, but thrilled. I popped in my ear buds, grabbed my Dh and we start walking. It’s a small hospital and L&D is just a little “L” but I walked and walked. Back and forth. Grooving to my music. I don’t do Enya and waterfalls when I am in labor. I prefer to sing and dance. I was pacing to “Dancing Queen.” Unfortunately it wasn’t really working.

I’d pass the nurses’ station and my nurse would raise her eyebrows questioningly and I’d shake my head. Finally after an hour passed I decided it was time to really get down to business. I was determined to not be up all night and equally determined not to need Pitocin.

I sent Dh to dinner and asked for a birth ball. It was about 5:30pm. I turned on my ‘baby’ music, sentimental country and Michael Bublé-type songs, something to get the emotions going. I sat on the birth ball and did some nipple stimulation. Within 15 minutes I had two good contractions and that was all she wrote. I was in active labor.

I was pacing around the labor room when Dh got back. A, my nurse, put me on the monitor for 15 minutes, which showed a happy baby and active pattern and then I was off again.  For a little while I walked the halls, this time much slower, stopping to put my head on the wall and sway my hips during contractions. The nurses would give me thumbs up as I went by. It wasn’t long though before I knew I was done being out where people could watch me and I retreated to my room. I was starting to get vocal during contractions. During one good one as I stood next to the bed in a shallow squat, I growled through the contraction, A turns to me and says “Really cooking now, huh?” …smiles and keeps charting. That was the extent of her interference in my labor dance. Sometime during this Dr. K was called to tell I was in active labor. He came, watched me for a minute, asked if he could check me, I was a 6 and he said, “Great! Call me when it is time to have a baby!” 

The biggest disruption in my labor was shift change. I had had one nurse since I walked in the door at 9am and now, when things were getting pretty intense they changed. BOO! Luckily, I was blessed with another great nurse, D. I was back on the monitors for a few minutes. After a couple contractions I told D, “I need to get up and off the monitors!” She asked, “Just a few more minutes?” and I said “NO.” She said, “OK” and I’m off the monitors, never to be on them again. I mention to her that I don’t use leg rests and prefer to support my own legs etc. She said “Oh, Dr. K? He doesn’t like the bed broken down.” I also mention that I’d like the lights on low. “Oh, he doesn’t use the spotlight.” I am now very active and starting my litany of “I want to be done. I’m done. I don’t want to do this anymore. Can I just be done?” which I know means baby is coming soon but I always seem to forget that when I am in the thick of it.

I don’t stay in the same position for more than one contraction. I am most comfortable (as comfortable as one can be minutes before birth) standing next to the bed. I started to push during the peak of contractions and it was obvious baby was coming soon. D looked at me and asked, “Time to get Dr. K?” and I told her yes, it’s time, baby is coming soon. We had 15-30 minutes based on prior births. She calmly left to go get the doc. It’s just me and my husband and we’re both very quiet and concentrating. I have another contraction standing next to the bed and let loose with the classic, “uuuuuuuUUUUUNNNNGGGGGGHHHhhhhhhh!” The door burst open and in bustled a different nurse with her eyes wide and scared looking and snapping on gloves. “I HAVE TO CHECK YOU!!!” By this time the contraction is over, I’m out of labor land and look at her and say, “No you don’t. I’m fine. D went to get Dr. K.” “But I do!! I have to check you!” “No you don’t,” and this went on for a couple minutes until D walks into the room. “B, what are you doing in here?” “She sounded like she was pushing!!” “I know, I told you I was getting Dr. K, everything is fine!” and she bustled the hysterical nurse out the door. Dr K comes in a few minutes later with a smile, watches a contraction, says something quietly about it being almost time and then he just kind of stands off to the side. I’m still flipping all over the place, hands and knees, over the back of the bed, squatting. I request the squat bar and Dr. K tells some random nurse, “Get her the squat bar!” At this I look up through my ponytail hanging in my face. He is standing there, not gowned and masked, not wearing the HazMat suit all the other doctors do. He is wearing his scrubs, as always, and a pair of gloves, standing with his hands clasped, his hip kicked out and his glasses on his nose. Just watching.

Finally, I end up kind of perched on my left hip, with my arms wrapped around my husband’s waist and my face buried in his stomach and, “Here he comes!!” Dr. K continues to just stand there. My husband leans over and says, “When she says that, she means it.” Because my litany of labor whining has never stopped and the “Here he comes!” came out in the middle of “I can’t do this.” And “Am I done yet?” Dr. K springs into action!! Which for him means he twitches his finger at the nurse to push the delivery table closer and he walks over to the side of the bed the baby was going to land on. He bends over, tells me, “The baby is right. here.” With the next contraction I give my first real push and the head is out. Being the busy body I am, I direct Dr. K to “Get the shoulder, get the shoulder!” and I feel a hand gently push my knee back just a bit more, then I feel one shoulder go, then the other and then my little boy sliding quickly out. There he is!! Dr. K looks at him for a couple seconds and immediately gives him to me. The nurses throw a couple of warmed blankets over us and everything is quite calm. Max is extremely alert, breathing beautifully and absolutely covered in vernix. We had to wipe some off his eyes just so he could open them.

Dh and I wonder over our little guy. Dr. K monitors the cord, the unclamped cord and B (the hysterical nurse) listens to Max’s heart/lungs while he hangs out on me. After a few minutes, Max starts squeaking a bit and B starts rubbing him and saying “Good baby, give us a cry.” Dr K. pipes up, “Leave him be. He’s pink, breathing, his cord is still pulsing. He doesn’t need to cry.”

You have to understand that Dr. K has a very quiet calm voice but you would have thought he yelled at her. She backed off completely, like back to the baby warmer. Max started nursing, the cord stopped pulsing, the placenta came. It was all good. My perineum was intact, but I was bleeding. Too much. B was back listening to Max and when she looked down at Dr. K and D working on my lower half her eyes got all big again. That woman needs to learn to control her facial expressions. I knew I was hemorrhaging, it’s par for the course for me. I had told D that she should have Pit hung and ready and she had listened so there was already a bag of Pit ready to go. They hooked it up and opened it up wide and were doing all the usual things. I may have received other meds too, I don’t recall, I was pretty wrapped up in my baby. The bleeding slowed to acceptable levels although I would end up anemic and it would take me weeks to catch up. Max was over an hour old when they asked if they could take him to the warmer, examine and weigh him. A little while later we went to the Postpartum floor and had a nice uneventful postpartum stay.

It was a lovely birth. I never felt that I was being “managed” or controlled. Despite my laundry list of risk factors I was never treated like a ticking time bomb which has often been the vibe in previous births. The memory of it really helped carry me through the following week when Max was admitted to the Children’s Hospital for what turned out to be viral meningitis that he caught from a couple of his siblings. In big kids it was a fever and headache that was easily controlled with a dose of Motrin and going to bed early one night. In a 4-day old it ended in a three day hospital stay on a monitored unit.

#10 is on his/her way. I pray we get a similar experience and outcome in April 2012. I know that with Dr. K in my corner I at least have a fighting chance.

Monday
Nov212011

Mindfulness

So you’d think a midwife with nearly 30 years experience would have living in the moment down pat, right? Not quite. In fact, I’ve struggled with “meditating” and even “breathing”; as much as I’ve tried, I’ve continuously failed.

Not anymore.

I’m in the throes of a deep clinical depression. When I’m depressed, which has happened far too many times in my life, I sink into a place where I, eventually, am unable to write even short pieces, hence my lack of posts over the last few months.

This depression was a culmination of several difficult experiences including leaving homebirth midwifery and Zack’s coming out transsexual. There are other, more personal, reasons, but those major two are enough for the purpose of discussion.

In my quest to stay out of the hospital, I’m in an Intensive Outpatient Therapy Program (IOP), attending group therapy 3 days a week for several hours each day. I also see my private therapist and psychiatrist, each having a hand in re-creating my sanity.

I’ve been in therapy much of the last 30+ years, but in the last couple, an entirely new method has taken hold and I am benefitting from the immense changes in mental health today.

Cognitive Behavioral Therapy (CBT) in Psychology began in earnest about 2006 and despite its fancy name, it basically means The Power of Positive Thinking & BEing in the moment. For those that do yoga or who meditate, this is old news to you. I’m sure seeing these methods used in psychology is a big “duh!”, but know that, for the first time, I get it. I can finally see the negative self-talk I’ve done my whole life and see how I ruminate and worry my life out of the present moment. In my IOP group, I am learning skills to keep me in the moment, not as a goal towards success in life, but to help me understand and accept and find peace in what is and to let what isn’t float away like clouds on a breezy day.

This all sounds so woo, doesn’t it? Monks and yoga teachers, Buddhist lessons and Hypnobabies classes all teach how to stay in the moment. Even as a midwife, how many times have I said, “Stay with this one contraction. All the ones past are gone; the ones in front aren’t here yet. Be Here Now.” Yet, I couldn’t even do what I was teaching. I’m using these lessons to not feel like crap about my lack of insight into the advice. (Float away, judgment!) In fact, it sounds so woo, I am shocked this is part of my therapy, the major part of my therapy.

Yet, I do feel better already and I have barely begun to understand what I am learning. A wonderful NetFriend read of my distress when I came out on my Facebook Page and sent me the most amazing book: Mindful Way Through Depression. Normally a very fast reader, this book requires I read it in short stints. It comes with a cd of guided meditations (which I have not listened to yet), but the book is so good, I’ve begun reading it to Zack. I figure if this is a new way of life (and mental health) for me, he should know what I am doing. Long understanding Be Here Now, Zack is thrilled I’m learning the skills he’s used his whole life.

So, here I am, 50-years old, digging my way out of clinical depression with the belief of To Think Is To Create. For the first time in ages, I feel, in the here and now, a great deal of hope.

Saturday
Nov192011

Dear New Midwife Blogger,

Please learn that it's HIPAA, not HIPPA.

Please use spell and grammar check.

Please know how to space and use punctuation.

Please use your own mind; don't be a sheeple.

Please examine every single thought that goes through your head. Three times.

Please have a great time writing.

Monday
Oct312011

Interviewing a Homebirth Midwife (Finale)

This whole series has been filled with putting the bulk of the responsibility on the client with regards to choosing the most qualified midwife for her birth. As some have pointed out, this is quite the backwards way of choosing a provider. Usually, a provider has a certain level of education and skill before taking on clients (or patients), but the reality is non-nurse midwives in this country (Certified Midwives, notwithstanding) have an education that is all over the place. In every part of the country, and even within the same city, you can find women who’ve been to three births and read Spiritual Midwifery and then hung out their shingles right next door to Certified Nurse Midwives who have their Bachelor’s Degree in Nursing and then advanced training in midwifery, all doing homebirth. Because of the haphazard reality of midwifery in the United States, it’s become imperative to figure out who the most competent midwife is, the one you are entrusting to save your life and that of your baby if every rare disaster comes to pass.

While many (most?) women wouldn’t have one clue what they were looking for if they went to a Skills Training, one thing all women can do to be sure the midwife they hire is absolutely sure of her skills is to insist she be recorded during the birth. If I were hiring a homebirth midwife today, I would require her to sign a release stating I was going to record the entire labor and birth and it would not be turned off in an emergency. As a midwife, I can tell you the prospect of being filmed during an emergency is scary as hell, but I know it will give the client the complete power over her own birth, ensuring the midwife she hires is totally sure of her skills and education… so sure she is willing to be forever captured digitally. the one that will sign a release allowing you to record the birth.

If all the midwives in the area get together and refuse this requirement, that gives you a lot of information right there, too. First, the midwives protect each other, even when trouble ensues. Second, that they don’t trust themselves to be recorded. And lastly, it isn’t all about the mom and baby; it’s all about the midwife. If this happens in your community, I would be very wary of a homebirth. In fact, if I knew I was a great homebirth candidate and found a wonderful midwife whose peers said all midwives needed to refuse to sign such a statement, I would record my birth anyway, with or without her signature. Hospitals are forbidding recording of births more and more and that irks me no end, enough that I’ve thought about hidden cameras.  I’m not attending births right now, but it’s definitely been a consideration. Isn’t it just sad we have to think of a lawsuit, far in advance of the possibility? Sad, but true.

So, that’s it for now. Know the answers you’re looking for, become as close to your own midwife as you can and make sure you have the most qualified midwife in your community (not the cheapest or even the most popular).

I look forward to hearing how these ideas work as women implement them (if they implement them).

Good luck to all you women hoping for a safe homebirth; I’m on your side.

Monday
Oct242011

My First Homebirth (as a witness)

I remember my first homebirth. I was working at a busy birth center as an assistant to a group of CNMs and also working at another slower birth center, both in Orlando. I’d already attended over 200 hospital births, so the baby coming out of the vagina wasn’t the overall lesson of the experience, although it is always miraculous and wonderful. I’d been invited to attend this homebirth by a lovely CNM who wore a flower behind her ear anytime she left the house. I was asked to come along to help her if she needed it, but I ended up sitting quietly, watching all that went on with this mom’s labor.

The atmosphere was calm and quiet, despite there being her husband, a couple of friends and her first child, a toddler, running around the house. No desperation, no rush to do a vaginal exam when we arrived, no asking her to move here, or scoot there; the midwife met the woman where she was and shifted herself around the labor. I was pleasantly surprised.

Compared to the hospital, the energy in the room moved as if through thick, syrup-y air, a sort of slow motion, purposeful, advancements of arms and legs. Words, too, wafted around the room like sweet smelling smoke, curling it’s drifts… rising, then falling… eventually evaporating, but leaving the scent of intense focus, both from the mother as well as the midwife. I remember thinking everyone had that shimmery glow we see on the road during a baking summer car trip, trails of color that followed anyone that moved.

We arrived well into labor and after an initial lull when we arrived, it picked up again quickly, bringing her to delivery a couple of hours after our arrival. The baby tumbled out and into the midwife’s hands, which immediately brought him to where he’d just been, but this time, on the outside of mom’s body. His mother elatedly embraced him, a look I’d seen many, many times before, but this time it was… quieter? More peaceful? The midwife didn’t push a stethoscope to the baby’s chest or back, even under the blanket, but casually felt the cord and saw the baby doing just fine, leaving mom, dad and baby to get high within their own bubble of joy.

The rest of my time as a guest in this family’s home, I drifted in and out of my own ponderings of the difference between hospital, birth center and home births. They were distinctly different, each holding their own importance, but I wondered how anything outside the home could possibly mimic what I’d experienced that night.

So far, nothing has.

Saturday
Oct222011

Interviewing a Homebirth Midwife: Skills Training

Too often, when the discussion of a homebirth complication comes up, the ineptness of the midwife’s actions comes into play. How would a potential client know if her chosen midwife is up-to-date and practiced with her skills? I’m going to propose something completely unique to anything I’ve ever heard before, an addition to the interview process that might actually have a hand in 1) helping women choose the most competent midwife 2) help midwives practice their skills until they are body memories and can be done in their sleep… or during an acute emergency. 

Ask to attend a skills training session with the midwives so you can see who is the most adept handling the fake emergencies. You don’t need to know how she is supposed to handle a shoulder dystocia or a surprise breech because they will be discussing that in the session. You’ll get an idea of who the “leaders” are as far as teaching the skills (usually the midwife with the most experience in that skill) and who has the least knowledge about a certain skill. I believe just asking to attend this type of session would give you an enormous amount of information about the level of transparency and disclosure the midwives in your area offer. If you’re refused entry, that speaks volumes. If you’re permitted in, that also speaks volumes. 

Skills that should be observed:

  • Starting an IV
  • Suturing
  • Neonatal resuscitation
  • Adult CPR
  • Shoulder Dystocia resolution
  • Surprise Breech
  • Surprise Twins
  • Cord Prolapse
  • Postpartum Hemorrhage
  • Calling 911

It's unlikely you'll be seeing all those in one session, but that a group of midwives even putting on a public session says great things about their willingness to display their knowledge and skill.

I do agree midwives deserve to have a safe space in which to learn and grow their skills, but if holding a public skills session forces the wary midwives to practice their heads off for the event, everyone wins… especially the mom and baby. 

I look forward to feedback from moms about how this request works in your community.

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