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Saturday
Jul282012

Making a Hospital Birth Plan

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

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

Birth Plans on the Internet are woefully out of date.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

Onward....

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My Birth Preferences List

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

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

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

Labor

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

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

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

Birth

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

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

Cesarean

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

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

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

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

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

Baby Care

- No Erythromycin eye ointment, please.

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

- No vaccinations are to be given at this time.

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

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

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

Labor

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

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

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

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

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

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

Birth

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

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

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

Cesarean

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

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

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

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

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

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

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

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

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

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

1. You will be letting your wishes known.

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

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

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

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

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

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

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

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

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

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

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

(More on attitude and goals further down.)

Baby Care

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

     1) Because they don't have gonorrhea or chlamydia

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

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

     4) Because they feel it is invasive.

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

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

Families might choose to avoid the Vitamin K:

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

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

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

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

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

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

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

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

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

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

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

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

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

Finishing Thoughts

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

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

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

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

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

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

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

Sunday
Apr172011

1986 Birth Plan

25 years ago (exactly!), I sat with the Neonatologist and Head Newborn Nursery Nurse of the Frankfurt Regional Army Medical Center in Frankfurt, Germany. My water had broken five days earlier, so the much-planned-for homebirth with the German midwife (hebamme) was out and a birth in the military hospital was in. I'd had a UC birthing Meghann and while I didn't want to do that again, I also didn't want to have a baby in the hospital. But, here I was, preparing for what I didn't want.

I know! Five days earlier? You can read Aimee's complete birth story to hear the details of how it came to be that I delivered my baby in the car seven days after my membranes ruptured.

Here, I share the Birth Plan I worked out with the doctor and nurse that Friday afternoon. And yes, it's true... the nurse typed up my birth plan. And we all signed it. Rare, indeed.

Rarer still, they obeyed it to the letter.

It seems like a minute ago I was sitting, hugely pregnant, negotiating what turned into a great birth story. Aimee turns 25 on Wednesday. All I can say is "Wow!"

 

Monday
Feb142011

Thoughts on "One Born Every Minute"

You can’t Google about natural birth the last couple of weeks without coming up against half a dozen posts or articles critiquing the new show on Lifetime, One Born Every Minute. One of the most vocal was Gina, The Feminist Breeder, who wrote “Lifetime Shows Us There’s One (Unnecessary Intervention) Born Every Minute.” Gina says,

"So I couldn’t help myself.  I took notes the entire way through this train wreck and yelled at the television every 60 seconds.  Here is what I saw, and here (in blue block quotes) is what I yelled at my TV."

Kristen, from Birthing Beautiful Ideas (a blog I’ve never seen before… how have I missed this?) writes in her post Dear Lifetime: It’s not Weird, it’s Normal,

“… I worry about pregnant women and their partners watching “One Born Every Minute.”  And it’s not because I think the show is going to make them want to run out and ask for every birth intervention in the world as if they’re candy.  Rather, I worry that the show will create or even reinforce in women’s minds a pretty bogus distinction between  “What’s Normal and What’s FREAKY-DEAKY-WEIRD-AND-ABNORMAL During Labor.”

I’d considered not watching the series, but since I’ve recently hung up my homebirth midwife hat and picked up my full-time monitrice-doula hat, I thought, “What the heck… how different could it be from what I already know to be true in hospitals?”

Last Tuesday night, I watched both the first segment, “To Medicate or Not,” (the one that had the natural birth couple in it) and the second installment, “Expect the Unexpected”; Sarah left the room. (You can see the full segments in those links.)

It turns out I was right; the shows weren’t all that different from my own personal hospital experiences… as a doula or as a midwife who’s transferred/transported women to them.

I didn’t sit screaming at the TV. I didn’t get high blood pressure from enormous amounts of frustration. Sure, I rolled my eyes a few times (some things said and done were absurd… more below), but, hard as it is to say, I stand behind the “You Buy the Hospital Ticket, You Go for the Hospital Ride” belief I’ve had for years. I don’t know if 28 years in hospitals has numbed me (I don’t believe it has at all) or if my idealistic belief that I Can Change The System has been flushed down the toilet, but I have pretty much given up any hope of seeing massive institutional changes in that area of the birth world.

When I first started, I thought things were so awful –the induction rate, the cesarean rate, etc.- that they couldn’t possibly get any worse. And look! Not only has it gotten worse, it’s gotten horribly worse. I’ve come to the realization that, until we have a 100% scheduled cesarean rate, it can always get worse. Of course I pray for a miraculous change in The System, but I’m just not going to hold my breath anymore.

 So the TV show. I tried to watch it from two viewpoints… one, from a mom who knows nothing about birth and two, from a sociological point of view. Marrying the two, I definitely winced thinking of the messages being conveyed throughout the episodes.

The first was how Blessed (gloriously, exaltedly Blessed) an epidural is. I would swear someone (or many someones) in the epidural industry is paying for product placement in shows like this. I almost sat and counted the number of times “epidural” was said, but decided it was pointless; we all know how many times an epidural is brought up in labor already. And giant pet peeve of mine: “Her epidural,” “My epidural.” Ugh. How did this procedure acquire possessives? Counter that with a cesarean. Rarely do I hear women say, “My cesarean.” It’s usually I had a cesarean.” Are women claiming ownership to the epidural because they can remain more “civilized”… more themselves? Versus a cesarean that very nearly transforms the woman’s perception of herself or, at least, her body? A great topic for someone who studies these things.

Women on the show were so passive. Their bodies doing things they had no knowledge of until someone (or some machine) told them something was happening. “Oh! I’m complete?” I know this is a duh kind of obvious to those of us who know natural/normal birth, but the message is ghastly to those that don’t know any better. It was so funny (not haha), the woman who was on the birth ball, in the shower… she looked so out of place! The same way a woman in a homebirth who did nothing but lie on her back in bed would. Isn’t that just sad?

It’s true, the show capitalized on the friction between Nurse Pam and the natural birth mama, but even in the second installment when there was no natural birth juxtaposition, we could see who the nurses smiled with, who they joked with and who they were the kindest toward: the women who didn’t cause any extra work for them. If a woman needed her belts adjusted because she moved or even if she had “annoying” family members, you could almost hear the heavy sighs as they had to go out of their way to do the task or speak to the family member. Never mind these things are part of their job; if they took an extra two seconds, it seemed an extreme bother.

This is one of the main things I feel I can offer my clients (slight segue), that I work well with hospital staff, helping wherever I can, helping the nurses not have to do things like moving the belts or changing chux or whatever. I’ve spent many a-labor holding the monitor on a swaying, moving mom. This delights the nurse who really doesn’t care if mom’s mobile and rocking, as long as the baby can be seen. I think this was where the natural birth mom’s doula could have helped a lot, by holding the belt on the laboring woman’s belly when she was on hands and knees. If the woman is anywhere near the monitor… on the ball, standing, rocking, etc… why not have her on the monitor so you can get her off without any issue when you want to later? Making the nurse happy AS the woman gets her needs (wishes) met creates a much more pleasant atmosphere and the client has better post-birth memories.

I had a transfer not so long ago and one nurse was initially guarded with me, but warmed up quickly. During the labor and birth, I was encouraged to take a more active physical and even clinical role than I know would have happened if I’d have been Guard Midwife. The birth became a wonderful, empowering moment for my client… her wishes honored and honored respectfully and happily… not just because she was compliant (she refused more than one recommendation), but because everyone was clearly listening to and hearing each other. As I was leaving, the nurse thanked me for all my help and told me it was refreshing to see a homebirth midwife not be combative, that most of the other ones she’d seen have been “bitches.” (Her word, not mine.) I left vowing to repeat this positive experience, that I would work hard not to have my midwife-monitrice-doula interactions be contentious and, somehow, find a way to also help others have a more harmonic hospital birth experience without sacrificing autonomy and self-respect.

I would be remiss if I didn’t mention two incredibly huge gaffes and one smaller one that one of the nurses made. First, when a baby’s heart rate was going down and mom was worried, Nurse Linda, a tiny, older nurse (second segment) told her the baby was just getting used to her lower blood pressure… that she’d had high blood pressure and now it’s normal, so the baby has to adjust. I can only assume this was right after an epidural was placed (can’t tell from watching), but what a stupid way to explain what was happening. The baby’s “getting used to a normal blood pressure?” Geez.

The second thing this same nurse said that nearly had me falling out of my chair in disbelief was when a mom was pushing, had been pushing for what seemed to be about two hours at that point, and as the tiny nurse was showing a family member how the head came down and receded with each push –while the baby was still inside - she casually says, “Oh, that’s turtling.” Uh, no it isn’t. Turtling is when the head is born and then is pulled back up, mooshing back against the perineum. Said more clinically:

“Once the shoulders impact at the pelvis inlet, the fetal head which has already left the pelvis, often recoils tightly against the maternal perineum. This is termed the ‘Turtle sign’…”

photo by Kristina Kruzan

The woman did, later, have a shoulder dystocia, but the turtling had not happened yet. I wonder what the other nurses –and the tiny nurse’s supervisor- had to say about her clinically incorrect remarks.

The third was when a mom was on hands and knees and her sister made a snickery comment about her being “doggie style” and Nurse Linda pipes up, “We prefer to call that knee-chest.” Excuse me? No “we” don’t; we call it hands and knees.

I acknowledge I’m not like a lot of Natural Birth Advocates (NBAs) who refuse to watch these types of shows. Besides watching as an informal continuing education, they are what many pregnant women watch and I like to be able to answer questions regarding what they’ve seen on them. Bloggers and commenters have begged for a realistic (not reality!) show about homebirth, but honestly? I don’t think it’s dramatic enough to show. And don’t we like it that way?

Saturday
Jan012011

Midwife to Monitrice

Today begins a new chapter in my life.

For those that know me, that is hardly unusual; I almost thrive on new beginnings! I’ve started and stopped several adventures since I’ve been back in San Diego these last eleven years. I thought about making a list, but simply reading through my blog, you can recount many of them for yourselves. laughingwink

But this new start is more profound; doesn’t include learning additional skills or investing in a start-up kit. Instead, this undertaking capitalizes on the very best of who I am –as a woman and as a midwife.

Today, I’m setting aside my homebirth midwifery career. In this moment, it seems long-term, maybe forever, but, as a woman and as Barbara E. Herrera, LM, CPM, I reserve the right to change my mind.

While my homebirth practice is being set aside, my midwifery licenses, knowledge and passion for birth remains intact.

I’ve been attending births for 28 years now (the anniversary is in two days) and over that time, I’ve been able to observe myself in a variety of childbirth settings and roles… from hospitals, birth centers and home… to doula then midwife. I’ll be fifty years old in two months, twenty-eight days; I know myself pretty well by now and it’s time I utilize my strongest attributes.

Today, I offer myself as a Monitrice and Doula to women birthing in the hospital. 97% - 99% of women have their babies in hospitals and, as most of us know, that can mean traversing a maze of technical and mechanical obstacles if one desires a more peaceful, physiologic birth experience. Even while choosing to (or having to) have their babies within the confines of a medical institution, I believe women have a right to autonomy and a peaceful, enlightened and empowered birth. I will not be conferring peace, enlightenment or empowerment, but I want to be a font of knowledge and skill from which a woman is able to drink.

It’s been interesting, this mental shift from midwife to monitrice/doula. I’ve wrestled with not seeing what I’m doing as a step backward, but a step sideways. A wise woman pointed out that I surely felt as if I was going backwards because so many of us in birth see being a monitrice and doula as a stepping stone to midwifery. But, perhaps the phrase, when asked if she’s a midwife, a woman says “I’m just a doula” needs to be abolished. What if we were able to say, “I’m a doula,” “I’m a monitrice” or “I’m a midwife” with equal pride and delight in our voices. (Hear me talking to myself?)

As a monitrice, I will be hired to help a woman who’ll be having her baby in the hospital, but who wants to stay home in early-to-mid labor safely. She’ll begin contractions (or her membranes will spontaneously rupture) and then call me. Once she’s begun her labor in earnest, I’ll go to her home and, for all intents and purposes, I’ll be her midwife as long as we’re there. I will keep a chart on the mom, monitor fetal heart tones, the mom’s vital signs and if she desires, check cervical dilation periodically. Then, when mom says, “It’s time to go in,” or if I say, “It’s time to go in” (either because birth is becoming imminent or there is a concern for either mom’s or baby’s safety), we’ll head into the hospital and there, I will become her doula, attending to a woman in all the wonderful ways a doula takes care of her client.

When a mom hires me as a doula, I will meet her once she’s in the hospital and laboring actively. As with the most doulas (who’re worth their salt), I will not interfere with the medical aspects of her labor, but will be the emotional and physical support she needs and wants. The benefit of having a midwife-as-doula is I recognize and understand the plethora of technical and medical lingo as well as the actions that go along with them. If a mom’s able to maneuver within the medical constraints, keeping the baby and herself safe, I’m utilized at my highest abilities. I know how to work those monitors, keeping them on mom and baby, holding the transducer on the baby’s heartbeat if I need to. The technology in the hospital doesn’t intimidate or scare me; I know it all well. (And, I know! I should have been a certified nurse midwife! Alas, in another life.) I know how to support the nurses so they’re better able to attend to my client. I’m comfortable seeing myself as an ally with the medical staff as opposed to an enemy, as someone hired to protect a woman as if I were a castle wall. I know, because I’ve seen it, that kindness and understanding between doula and nurse helps a laboring mom far, far more than antagonism and distrust. I’ve listened to doula after doula tell me how they despise hospital births, how they’re burnt out from watching birth violence and being so helpless to do anything about it. I’ve watched as doulas fall by the wayside of hospital births, some even saying they will now only doula with certain hospitals, doctors or even only for women who’re having homebirths. My heart asks, “Who helps the others? Are those that might need a doula most be left wanting… nay, needing… someone to, at the very least, bear witness to the assault upon their bodies and hearts?” I have a knack for helping women process difficult births; maybe I’m supposed to be one of those that replaces an overwhelmed, traumatized doula.

I believe in the benefits of birthing in a hospital. While I absolutely believe many, if not most, women can birth safely in the home, the reality is that isn’t happening –and doesn’t seem to be happening anytime soon. Hospitals, to me, are not The Enemy, but can be vital links to connect a family to their newborn. I believe the System as it stands now can totally use some re-vamping, some areas even in very dramatic ways, but unless someone (many someones!) stands within and humbly (or even arrogantly!) offers solutions, nothing will change. I don’t know if I’m that person and, honestly, it isn’t remotely on my agenda as I step into my new roles, but who knows what affect any of us has on another person… or institution… unless we do something.

I wrote “When You Buy the Hospital Ticket, You Go for the Hospital Ride” years ago. Sadly, it’s still a common refrain for most women to endure. I am only one woman… one old-ish, fat, loving, smart birth-loving woman… but, even I want to make my mark in the world. Imagine the stories I’ll now be able to tell! It doesn’t seem that homebirth midwifery was my (only) path. I’m setting out on another and from what I can see from here, the ways seems brightly colored, flower scent-filled and gloriously luminous. 

Once again, here I go.

Friday
Dec312010

Light Switch

“What was the light switch that turned you from a sheeple to a natural birth advocate?” was the question asked on my Navelgazing Midwife Facebook page. These were the answers. 

KS-R: Ina May's Guide to Childbirth. I don't remember why I bought it, but I’m glad I did. 

ABP: Getting pregnant with #1 and knowing I didn't want drugs and intervention pushed on me. 

CM: The birth of my second child. I went into labor with the attitude that the nurses had my best interests in mind and would do whatever possible to make sure I had a wonderful birth. It didn't happen like that at all. They bullied me, made it sound like I had no option except to lie in bed and labor, gave me Demerol against my wishes and overall extremely mean. I vowed never to go through that again and after hearing so many stories of how other women have gone through the same thing, I began my studies to become a doula. I had a beautiful birth with my third child and want to help women have the best birth possible. 

SD: I can tell you the exact moment actually. I had a doula friend in Des Moines, IA who had been talking to me about and also pushing me to take out-of-hospital birthing classes, even if I didn't follow any of her other advice. I picked a wonderful doula and childbirth educator and took her class. The first day of class, we did an exercise that is from Birthing From Within I believe. She asked us to draw what a C-Section looked like to us. I quickly drew a cold hospital table, with a Mom on it, with blood rushing out, a baby being yanked out and a terrible awful sad look on the Mom's face. Then I burst into tears. Loudly. I did NOT want my baby to be born into an environment that even remotely resembled that picture. It scared me so much! I went on to hire that woman to be our doula, had a birth center birth with a midwife, and haven't looked back since! 

KF: My births. First one, the typical American birth with all the drugs and complications. Second one, very low intervention with a midwife and we got a computer with internet access. There wasn't a lot of information available when I had my first baby in 1996. 

AC-M: Getting bulldozed in every aspect of my first birth definitely did it for me. I felt so powerless and helpless during the whole thing and even afterwards. I positively will not allow that to happen this time. 

EC: I am one of those people who reads everything I can get my hands on when I am faced with decisions. After my horribly mismanaged miscarriage, I started reading about options other than OBs. This lead me down the rabbit hole and I discovered I was far more "granola" than I thought I was. My previous thoughts of getting an epidural as soon as I got pregnant went out the window as I found out more about the cause/effect of interventions. 

JT: First baby--22 years ago--went to the see the OB after getting a positive home pregnancy test. He told me I could not be pregnant because I had not medically treated my endometriosis. I told him I used homeopathy and nutrition and he said "that doesn't work". I walked out and told my husband I could not have a hospital birth. I had never heard of homebirth, but found someone within a few weeks. 

EN: I saw The Business of Being Born. Ina May (Gaskin) is interviewed in that documentary, so I progressed to reading Spiritual Midwifery and never looked back. 

JD: looking at VBAC options while suffering secondary infertility; quickly found my options weren't options at all, ended up on the ICAN (International Cesarean Awareness Network) site and the rest is history. 

ALJ: Realizing that Dr. Stabby-Hands lied to me once I started researching the undeniable symptoms of the condition he diagnosed to justify our "emergency" c-section. 

SE: You were my light switch, Barb. 

Thank you!! 

LC: Getting yelled at by a nurse while purple pushing because I couldn't hold my breath long enough. Luckily my midwives with my 2nd and 3rd would never have dreamed of doing something like that. 

EWB: I was 13 and my pastor’s wife had just had a baby and she said to me "Emily, when you have a baby, don't go to the hospital - they won’t even let you eat while in labor." At 13 I couldn't believe the forced starvation. I followed her advice and never went to a hospital - motivated by food! 

JWP: There wasn't a one time thing. I went into birth wanting natural and ended up with an induction and c/s and I've just progressively gone from there. I've had 3 VBACs now and have learned even so much more after this 4th baby. I now want to become a CNM

CR: The fact that I hate hospitals with a passion and really didn't want to be subjected to someone telling me how I needed to have my baby. 

CS: When I was 13, I babysat for a La Leche League/natural birth/co-sleeping mama. Back in the 70s! It’s all Connie's fault! 

EG: I went to my sister in law's birth; she was induced and didn't even care about seeing her baby - she was just looking at the menu. When they asked if she wanted to hold him or have him cleaned off first - she chose the latter. It creeped me out how cold and unconnected it was. 

EHS: I am so lucky because there was no aha moment. I was a little girl who studied things and questioned the status quo. I was also lucky to grow up sleeping in the handmade bed frame my mom was born in. So I was able to extrapolate that birth at home was normal. 

KF: What is really sad for me, having worked for many years as a doula, are those women that don't WANT the information that I was unable to get with my births. I'm just astounded. And when a mom says she wants a low or no intervention birth, proceeds to hire an OB who is the MOST intervention-minded, and I TELL HER and she doesn't switch - I don't get it! But it's not about me. I have to let those things go. 

RG: When I got pregnant, my friend gave me the Lamaze Guide to Giving Birth w/ Confidence. I was amazed that hospitals aren't set up to give women the best birth possible. That put me on the road to homebirth and now doula work! 

BJ: Endometriosis and figuring if I don't pass out in labor, it can't be as bad as a period. 

SS: Was born with it switched on. My mom had me at home after two hospital births. One a nightmare of medical pestering that has left her with serious urinary tract issues and another where she arrived intentionally just as she was about to push, and they insisted on separating her from her baby. I was a home birth. My sister was the first person to hold me (she was 10 at the time). I was born in my parent’s bedroom with the lights dimmed. 

I grew up with a healthy respect for things, since my mom told me our birth stories. She talked about the safety precautions the midwives took (apparently because of law, they had to hire an ambulance to wait in their driveway while I was being born), the feelings that she felt, what everything felt like, etc. 

I also grew up surrounded by animals and seeing animals give birth and care for their young. So my mental images of birth are of birth. When I asked my mother questions about "does it hurt", etc. her answers were honest according to my experiences in my births. That yes, there can be pain but that it's a different type of pain and that our bodies are strong and were born to give birth. 

AH-T: When I witnessed my nephew being held inside my sister in law because the nurse wouldn't deliver for "insurance purposes". I knew that I would never let someone tell me when I could or couldn't push or that I had to wait for some doctor to get there. 

Stories like that disgust me. 

NM: The booklist my OB insisted I read including “Spiritual Midwifery” & Immaculate Deception

Wow. Wow. Wow! Immaculate Deception, apparently, is a very difficult book to find. Even Suzanne Arms’ site only offers Immaculate Deception II. If you have a copy, hang on to it! 

PK: Pushing out a sunny side baby (my third baby and second Occiput Posterior) after 2 and 1/2 hours of pushing at my first homebirth. She was 8lbs 14oz. I realized that Natural Birth was the way to go after that, and felt I could do anything if I could birth a baby that size who was OP. My previous baby born at the hospital came after 2 hours of pushing (they had no clue she was sunny side up, duh...) and the help of the vacuum which was a b!tch because I had let the epidural wear off and I felt her being ripped out of me (I tore as a result also.) I've had a total of 3 homebirths now and at no time during any of them have I ever felt any kind of pain like the pain I felt when my OB pulled my second child out of me with that vacuum. I had the pleasure of seeing him at the hospital when my niece was born and telling him I'd had 2 more (larger) babies at home. 

TS: Believe it or not, it was an episode of A Baby Story that focused on Hypnobirthing

ACA: After having my first in the hospital. While I didn't end up like the many women who are forced into a c-section from being induced, etc., it was by the Grace of God and my God-given stubbornness (and my husband's refusal to allow the med staff to take control). 

I knew I would never have another hospital birth, but didn't know of other options, so I researched and found a home birth doctor who was great and the rest is history. I had baby 2 and 3 at home and am currently awaiting the birth of my twins who are due any day now and am having them at home. 

Life is good. 

NY: Caroline Ingalls, from Little House on the Prairie, says to Laura  concerning labor, "It's a good sort of pain." I was hooked!! 

NgM: How beautiful, all of you! 

I was a total sheeple with Tristan. I'd gained 70 lbs with him and did not want to repeat that, so when pregnant with Meghann, we'd just moved to Tacoma, WA, where I knew no one. The woman who registered me into the OB program at Ft. Lewis referred me to Marie Foxton, a prenatal and postpartum exercise instructor. Her studio happened to be really close to where we lived, so I went over there not too long after. 

Not only was Marie an exercise coach, she was also a Bradley instructor and LLL leader. Women in all stages of pregnancy and postpartum danced around the room, many with kids on their hips... and some even on the mom's boobs! I was fascinated. 

I took the pics of Tristan being born in to share... the blue drapes, the masks on everyone, the baby being taken across the room... and the women kindly oo'd and ah'd. Later, of course, I was astounded they'd been so kind. When I asked why no one said anything about how gross they were (to them), they smiled lovingly and said they trusted I would figure out the right way to birth for me... and they knew it wasn't going to be like that. 

They were right. I UC'd the next baby

KO: ‎@TS - YES!!! That was it for me too! I ordered HypnoBirthing the very next day. 

TC: I knew from the get go that being immobile wasn't going to work for a control freak like me. Little did I know that it was surrender that would bring my baby forth. 

CSM: I'm not sure… I was told throughout my childhood that I'd never be able to handle childbirth (I was a big baby if pain was involved) but somewhere along the way I realized things didn't hurt as much if I was the one in control. I knew I wanted an intervention-free birth long before I ever became pregnant. 

Ditto! I was told my whole life what a baby I was –and was-; but when it came to having babies, I was a lioness! It changed the way I saw myself forever. 

SP: Well, I had that "There is something not right about this" feeling after my first C section. I suppose reading Immaculate Deception and Spiritual Midwifery in the same week was what clinched it for me. Then after I had my first homebirth, it just seemed so simple that it was monstrous what I had been through to get there. 

TR: A completely unnecessary and very painful episiotomy at my second birth. I wasn't going to go through that again and I knew there had to be a different way. 

PNB: My first birth - Actually, I don't know that I was a sheep then either. I wanted a natural birth then, but for uneducated reasons. My first birth taught me to be educated. 

MPF: Educating myself, knowing our bodies are made to birth children, watching The Business of Being Born and knowing if I did try to have my baby in a hospital it would be a fight for natural vaginal child birth. 

KBH: There wasn't a total switch flip, as some of it had been there before, but I would have to say my long history of endometriosis really started it. How I was treated with that, being told at 17 to not expect to have children, going through medical menopause at 16, and taking two years and two miscarriages to conceive my first. I knew I may only get one shot and I wasn't going to be drugged or anything and miss it! After his birth, I only went deeper down the rabbit hole, and even more so after my second. 

LH: Reading every book I could get my hands on from the library and I came across Pushed by Jennifer Block. Haven't looked back since!! 

DV: Nine months of supporting one of my best friends during pregnancy (daddy is military and was out of state at the time) taught me a lot.  So did the 12 weeks of Bradley classes she asked me to attend with her.  But my light bulb moment was when mom acquiesced to amniotomy, which led down a path of intervention that included augmentation, pain meds which fractured her concentration, being tethered to an EFM and IV pole and all of the hassle of those entanglements, immediate cord clamping/cutting against mom's wishes - and the finale: a manual extraction of her placenta, because the care provider pulled too hard on the cord and it broke off.  It was like everything we were told, all the warnings we received, moved from hypothetical to 'this is actually happening.'

Watching other women experience pregnancy, labor and birth is no longer a remote landscape on the horizon that I catch a glimpse of once in a while and think, 'That's just some other country.'  Birth is in my own backyard now, and I exam every blade of grass.

M: I transfered care to a wonderful CNM, and when I asked her epidural or no, she told me that if I didn't decide in advance, I would have an epidural.  I wanted to have a choice, so I choose.  Now I'm a Bradley teacher, doula, and hopeful future natural OB.

KJ: I was never a sheeple.  Before my first birth, I knew that I wanted no drugs, no intervention.  My hubby wanted a hospital birth, and it wasn't worth arguing.  Over the last 13 years, I've had five babies, all birthed with no interventions, no drugs, all born in the hospital.  Each birth has gotten closer to ideal.  Each birth, I've learned a little more.  If I have a 6th (not likely, but possible), I'll birth at home, even though my hospital experiences have been good.  (I live in AZ, and I think, as a state, women are more "left alone" to do what they want to do, and less pushed, than in other locales.  That has been my experience, anyway!) 

HOWEVER, there was a light bulb moment for me, about being a natural birth advocate.

I'd always been rather laissez-faire about birthing:  to each her own.  I never encouraged ANYONE to do anything naturally;  I figured each woman had done her own research, and had just decided that they wanted an epidural (or whatever), in spite of their research.  Pretty much everyone in my circle knew I was a natural birther, and I figured if they wanted help, they would come to me.  It wasn't until a few years ago that I realized that most women DON'T do research and haven't come to their OWN conclusions;  they're just trusting the OB to do what's best, assuming that the OB is working towards the same goal that the mother is. 

The galvanizing light bulb moment, though, was about two years ago, talking to a friend who had a HORRIBLE, HORRIBLE vacuum vaginal birth with 4th degree tears, very alone, very confused, very unsupported.  She had wanted a natural birth, and didn't know what steps to take to help that happen, and assumed her OB was on her "side".  He wasn't.  She ended up with PTSD.  I didn't know her well at the time, but afterwards, in tears, I asked her if she would have allowed me to be present at her birth, to add support and to help her with decisions.  She then burst into tears and said, "I was hoping you'd ask!"

I realized that I had been so "live and let live" about the whole thing that I had missed countless opportunities to HELP other women achieve the birth they wanted.  Instantly, I felt the weight of guilt and grief for the mothers who might have wanted my assistance, but were afraid to ask, for all those lost births.  I'm not the "afraid to ask" kind, so it never occurred to me that women might WANT some help and direction and support, but not ask for it.

Duh.

I'm now doing the prerequisite reading to become a DONA doula, and have switched my modus operandi regarding birth and birth issues to be a much more active, vocal one.

C: My mom wanted a natural birth in 1987, at age 21, unmarried, deep south. she had her first c-section, because of 'failure to progress'. the next baby was also a c-section, and he was given up for adoption. then third c-section was in 1994 (I was seven), a miscarriage in early 1995 (I remember that day), fourth c in 1997, fifth c in 1998, sixth in 2000, and the final c was in 2005 with the only OB in town willing to preform a seventh c-section instead of a full hysterectomy and abortion. she still has her uterus, but pretty horrible endometriosis.

When I was twelve I saw a video of my aunt's accidental UC (midwife stuck in traffic and arrived to deliver the placenta).

I am grateful that my mom was always so open with me about everything baby, and that their history has taught me so much so young.

I am grateful for the lessons that I learned in my own birth experience. That while homebirth was the right choice for me, the hospital is not the enemy, they are sometimes supportive. I choose a kick-ass CPM,who labor sat for the long, slow 48 hours, and transferred for heavy meconium and who guarded the space in the L and D room while I worked through my acquired fear of hospital birth and taught me how to birth a baby.

L: My mom had 3 natural births which she always shared were very painful.  When I first got pregnant I was scared of labor, but knew that I absolutely did not want a c-section (lady at work had one).  I checked out a ton of books at the library, but the one I read first was The Thinking Woman's Guide to a Better Birth.  Then I was trying to figure out what kind of birthing classes to take and Amazon reviews ended up convinced me to try hypnosis, even though at first I thought it was way too hokey.  I ended up doing Hypnobabies Home study and became completely sold on natural birth and was excited.  I switched to a CNM/birth center at 6 months pregnant (fortunately it was a cheaper option thus I was able to convince my husband), and had a wonderful birth experience. With my second I was super excited about giving birth again, and this time chose a CPM but wanted the birth center again.  Unfortunately I ended with a c-section the second time around.  It really sucked. 

My one piece of unsolicited advice to every new mom is to interview their care provider.  No one listens though.

A: For me, it was watching The Business of Being Born.  In fact, I can tell you the exact moment in that movie when the switch flipped.  My friend (a natural birth advocate and survivor of a traumatic birth) took me to see it at a film festival and at first, I was quite skeptical and huffing about certain points, yet interested. 

But when they started describing the cascade of interventions, it clicked me for me.  I thought my hospital birth was awesome (and it was exactly what I needed/wanted at the time) but the third degree tear that took literally months to recover from (couldn't have sex for 6 months, it didn't stop hurting for another 3) was the worst part. 

As I watched the movie, I realized that a lot of the circumstances in the hospital conspired to create a bigger and more painful tear and that there were things I could do to help prevent or at least lessen future tears, I wanted to know more. 

I dug a scrap of paper out of my purse and started scribbling questions furiously and as soon as we left, bombarded my friend with them.  It's been almost 3 years since that night and I have devoured and learned and sucked up tons of knowledge.  I went on to have a beautiful, successful home birth with my son (second baby) and am now pregnant and planning a birth center birth for my third baby.

D: My 16 week IUFD when I was not told I could have an induction rather than a D&E, and when I asked about what happened to my child's remains I was told by the OB, "you don't want to know" so then I called the hospital after the procedure. The nurse on the other end of the line didn't know how to deal with me and when I asked what happened to my CJ's remains she first asked, "what did your doctor say," and then stated, "yes, you don't want to know." Then she coldly stated with annoyance, "they went out with the medical waste."

All along I had the right to ask for the remains, had the right to ask for an induction, had the right to have sonogram photos of CJ, but I was nervous and never spoke up for myself.

I began reading online and came across a few blogs (obgynkenobi led to atyourcervix who led to you....and other midwife blogs).

When I got a positive screen for t-18 with my 6th pregnancy, I had already begun reading your blog regularly. You had photos of Dr. Biter with a patient who had an OP baby who was having decels and he didn't do a c-section but had her move. In my labor, my OP baby was having decels that went down to 80. I recalled your photos at that moment and resolved in my head to do something, instead of staying on my left side, I argued with the nurse and sat up. Heartrate jumped immediately to 120. I have written you about this birth, I complied after that and the nurse was horrible, and that experience really changed me. I had a midwife for the next baby (my last one) and I have bloggers to thank really. Funny....

Very humbled, Dawn. Thank you.

Thank you… all of you. And feel free to add your own story. We’re all listening. 

Tristan's birth, 1982 (notice the nurse not wearing gloves). 

Me, in labor with Meghann (my UC baby), 1984   

Tuesday
Nov232010

Comment to “Ummm… not so much”

I was asked to remove the blog owner's name, she thinking her blog was private. Therefore, you will not be able to read the post I'm referring to. However, I'm leaving what I have because it's a great discussion even without the entire piece. She wrote “Ummm… not so much” about an article she read about a homebirth, how the article reaffirmed her decision to birth in the hospital. 

“One of her (the woman in the article she read) reasons was hey its the way people did it back in the day it must be the right way to do it. Well people also used the bathroom outside and took baths in the creek but we don't those things anymore right? What is so bad about having the baby in the hospital? I had a wonderful dr and labor and delivery nurse and I knew if there was a problem, I was in the right place. There was also the issue of her child being home for the birth. This lady was sitting on the toilet screaming having a baby while her child is coming in and out trying to figure out what is going on. At least take the child to a babysitter!”  

It’s so interesting reading others’ take on what many of us find pretty typical, if not downright normal. When moms or family members worry what the kids will think, I remind them that kids usually do better than grandparents… they don’t have the preconceived brainwashing they do. You know, no decades of watching fake-births in movies and on tv; to them, it’s not that big of a deal. 

Regarding the peeing in the woods analogy, I always find that so gross. Birth isn’t an elimination function… it’s the bringing forth of a life. And sure, there are advancements we can and should embrace, even in birth. For goodness’ sake, it’s a rare woman who wouldn’t accept medications for hemorrhage or blood products. And I can’t imagine any woman not wanting anesthesia for a cesarean, but when we mechanize the simplicity that is the majority of birth, that’s where the complaints come in. 

The analogy of hospitalizing a woman, putting monitors on and in her, people wandering in and out, measuring blood pressure and pulse… and penis size? while having sex with one’s mate… that’s what normal birth foisted into the hospital setting is like. An absurd picture, isn’t it? 

The blogger goes on: 

“Midwives can't give pain meds and u have to footprint ur child on ur own, they don't do it. They never mentioned going to get the baby checked out by a pediatrician; she just said they cut the cord and then she ate breakfast at the table with her expanded family and then they sat outside watching the other child play. What?? What about all those tests they give when the baby is born? What about height and weight? This article was a little disturbing to me. I understand this may be more comfortable for the mom but what about the safety of the baby? What if something went wrong?” 

Actually, dear blogger, if a woman wants pain medication in labor, she does need to be in the hospital because they are so patently unsafe she and the baby must be monitored. Even something as simple (simple?) as a sedative needs constant attention. Nothing given for pain is benign. Nothing. 

Most midwives do footprint, but it’s a memorabilia sort of thing since there is no chance your baby will be mixed up with another baby… something that can (and has) happen in the hospital. 

We do all the routine tests and administer the state required treatments -if the parents consent to them. Many (most?) of us also do the Newborn Screen which is done about day three postpartum.

Most midwives do recommend the baby be seen by a care provider, usually a pediatrician, within the first few days after a birth. We are able to keep a mom and baby safe through the passage of birth, but we are not specialists in complications of either. If there are any signs of a problem, they are referred (if not transported immediately) to a specialist (obstetrician/pediatrician). 

However, we do postpartum visits, checking mom and baby several times after the birth. My own rhythm is 24 and 72 hours, then two and six weeks postpartum. This is more observation than hospital birthing women get; once they are released from the hospital (24 hours or so postpartum), they are not seen again for six weeks. 

It seems the mom in the original article (that she does not name) was demonstrating the simplicity that is homebirth… that it was as easy as cutting the cord and then sitting down to eat her breakfast. But, I promise you, the midwife was doing much more than just scrambling eggs and buttering toast. 

We do examine the baby, head to toe and side to side. We weigh the baby (see the scale picture below) and measure him/her. How can anyone not want to know those basic facts? Besides, the weight is necessary for the birth certificate, which, in my state, I get to complete and file for the family, too. 

We watch the baby during the postpartum period, usually two to three hours, which is what happens in the hospital, too. We make sure mom is nursing well, that her bleeding is under control, that the baby’s breathing well and adjusting to the outside world nicely. We’re taking her blood pressure, both their temperatures, helping mom to the bathroom, helping her to shower, cleaning the room/bed, making the house so that you cannot even tell a birth occurred there. We start the laundry and make sure someone will be with her at all times for the next day or so. 

And if something goes wrong, we immediately attend to it and/or move into the hospital setting where, we absolutely acknowledge, they are the specialists in complications. We do carry medications to stop bleeding/hemorrhages, but if it continues and needs more help, we don’t hesitate to get the mom to the hospital. Why would we wait? As midwives, our most outstanding job is to keep the mom and baby alive. No “experience” is worth dying for. 

And having a homebirth is not just about “the experience” or to brag about natural birth. For most of us, it is to eliminate the massive amounts of technology shoved onto (and into!) women during birth. While the judicious use of technology is a great thing, the indiscriminate use is what’s abhorrent. When birth is going along swimmingly normal and the wonders of science are required (or highly encouraged) hospital policy, each intervention (continuous fetal monitoring, IV, remaining in bed, no food or drink, pain medications, etc.) carries with it enormous risks. In remaining at home, those risks are avoided and birth can continue unhindered by the commands of impersonal, faceless bureaucrats. 

So while you may still scrunch up your face at not ever wanting a homebirth… and you have that right, of course… I felt it was important to clear up a few misconceptions mentioned in your blog post. (I wanted to leave a comment, but the settings are not set to Name/URL, so couldn’t; decided to write here instead!)

Sarah (lifting) and me weighing Katelynn Belle.

(photo by Nova Bella DeLovely)

Tuesday
Jun292010

Dr. Biter Speaks Out (finally!)

Yesterday, San Diego News Network published their interview with Dr. Robert Biter (my “Dr. Wonderful”). It is the first public interview with him and I was so glad to see him finally speak up about what he was going through and how it has affected his patients/clients. 

Along with the written interview, Dr. Biter speaks, for 4:57 on (what is now) a YouTube video. 

Comments are welcome. 

Dr. Biter opens up, talks Scripps suspension

Wednesday
Jul092008

When Dogma Trumps Common Sense

I stumbled onto this blog post from someone who 1) seems to work in a hospital 2) hears great stories from friends who work in a hospital. You decide.

A birth plan, but no immediate mothering skills highlights the image of a rabid natural birth fanatic (and I use the term purposefully) as she moved from her planned homebirth into the hospital after she had ruptured membranes for 7 days and no labor to speak of.

(Those that know, know I also had 7 days between ROM and the birth of a baby, but I was under the care of myself and a sneaky group of CNMs. Don't know how tolerant I would be of another woman acting like I did! It'd need to be on a case-by-case basis, that's for sure.)

N E Way....

So the blog poster illuminates how stupid... er, strike that... ignorant? (not good either)... crazy? (probably a better word) an immobile natural birth advocate can sound when confronted with a change in plans.

(Edited for typos and attractiveness, not substance.)

(Begin quote)

- Her water broke 7 days before she ended up in the hospital. She had gone into a small town hospital (after the planned home birth didn't happen) that was not equipped to handle sections so was transferred to ours.

- She refused a section even though her baby was in DISTRESS; she had a birth plan and a section was NOT in her birth plan.

- She continued to refuse the section even though her baby was in IMMEDIATE DISTRESS because she wanted a natural birth.

- The doctor eventually had her agree to the section, not quite having to "hit her over the head with a hammer" as my friend so elequently put it.

- The baby was covered in meconium when born and even though he had not yet taken a breath she insisted he be placed on her chest.

- Couldn't happen becuase a) the baby wasn't breathing and b) her chest was in the sterile zone.

- They did place the baby on her chest immediately after he started breathing and the nurse stayed with them as the mother could't technically hold him.

- She refused to let the baby go to the nursery to be checked over while she was in recovery and wanted him left with her. As she had no partner and she was still somewhat drugged the ICN nurse had to stay as well, meaning she couldn't see to the other babies under her care in the nursery.

- When she was transferred to the maternity ward she had the baby lying on her stomach and the nurse suggested she lift the baby higher if she was looking to feed him. "Oh no, he will crawl to the breast if he is hungry." The two nurses say that newborns don't actually crawl to the breast and she says "Yes, they do! I saw it in a video." Editing, ya know.

- She refused to have a crib in her room and wanted the baby with her. When the nurse came in to do some bloodwork on the baby, the mom was sleeping and baby was nowhere to be seen. The nurse lifted up the blanket to find the baby with his face down in between her armpit and breast. Baby grey, no heartbeat, not breathing. Nurse rushes him out of room, all the while trying to get a heartbeat and breath. When in crib in hall, heart rate measures 40 (normal newborn in 100-160). If nurse had been 30 seconds later, baby would have been dead.

(end quote)

Even if we looked at the story through squinted eyes, believing some of this is exaggeration, I know this story is true because I have read/heard enough accounts from the fanatics themselves!

When you buy the hospital ticket, you go for the hospital ride.

As I recently said, hospitals have a huge responsibility to normalize birth within their walls, but for crying in a bucket, when there are complications, birth plans should be shredded by the women themselves.

When I have clients that move from home to hospital during their births, anything relating to the reason we are going there for now rests solely in the medical personnels' hands. It's what they're there for!

For example, if mom is laboring and there is lack of progress that sends us into the hospital, a birth plan that says, "No pitocin," isn't going to cut it. The part that says, "No erythromycin (in the baby's eyes)" is easy to adhere to because it isn't related to the reason for the transport.

Make sense?

If you have to move to the hospital because the baby has low heart tones, asking for intermittent monitoring is not only foolish, but dangerous.

Hmm. thinking

My frustration... let's see... part of it is it's embarrassing to have women be so adamently against something when that something can possibly save their lives or their babies' lives... all in the name of "natural childbirth." I'm not talking about the routine crap that goes on in hospitals, but the stuff that is really necessary when birth deviates from the norm.

Just like the hospital treating everyone the same and demanding that they stop doing that, it behooves natural birth advocates to stop seeing every intervention in birth as dangerous and weigh the risks with the benefits. Sometimes technology is fantastic!

The issue, of course, is how can you tell when the interventions are really necessary? So much of it depends on trust and distrust definitely sets the stage when there's mutual antagonism.

Walking in/being wheeled in with an open mind and heart can help tremendously.

Having an advocate... your midwife or a doula... not your partner (who is laboring right along with you) who can explain things to you as they unfold... a person you implicitely trust... someone with the experience to understand the hospital language, the interventions and their necessities... where was the woman's midwife in the above scenario? Was she UCing? (Sadly, it sounds like it from her rigid attitude towards birth and the hospital. Sad because UCers have a reputation that precedes them.)

And finally, believing that whatever happened was supposed to - for whatever reason. Lessons. The baby's choice. Destiny. Fate. However you are able to explain it to your psyche, it's important to integrate the experience so you are able to be a mother and a woman in your life.

None of this means there can't be distress in the experience, that women might not be coping with birth trauma or recovering from birth abuse, but integrating can mean the difference between immobilization and functioning.

Some women have found my The Gray/Grey Messenger: Recovery helpful when overcoming birth trauma.

It's a precarious place... needing to trust the hospital yet knowing many women are bulldozed into interventions they don't want/need.

Even though the medical folks tend to play the Dead Baby Card too often, it really is more important to err on the side of safety for both mother and baby.

I hope the mom in the above post is able to obtain some balance in her reality.

It's all any of us can ask for.

Friday
Jun202008

Response to ACOG’s & the AMA’s Homebirth Resolution

The resolution says, en toto:

Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or "lay midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM) recognize[1]; and

Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film [2]; and

Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery; therefore be it

RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers [3] (New HOD Policy); and be it further

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $1,929.

Received: 04/28/08

[1] http://www.acog.org/departments/stateleg/MidwiferyYearinReview2007.pdf, accessed March 18, 2008

[2] www.today.msnbc.msn.com/id/22592397, accessed March 18, 2008

[3] www.acog.org/from_home/publications press_releases/nr02-06-06-2.cfm, accessed March 18, 2008

I respond:

It’s true. Hospitals are a safer place for mothers and babies to be during labor, delivery and postpartum. If unexpected emergencies appear, as they sometimes do, hospitals have more personnel, more medications and more opportunities to save a mother’s and baby’s life (cesarean deliveries, hysterectomies, ICU, etc.). Simply by virtue of being in the hospital, women have every medical, surgical or practical tool at their disposal; this spectrum of options cannot possibly be offered in the home.

When women having homebirths have complications, where do they run? To hospitals.

I can understand the thought process of doctors:

How come hospitals are so sucky as a rule, yet they are the gleaming white knights in an emergency? Why do we have to “clean up” the mess made at their beloved homebirths? Why do we legally risk ourselves when too many midwives don’t even have malpractice insurance? Why are we expected to accept patients whom we know nothing about in the middle of a life-threatening crisis and the midwife is able to release accountability and become the woman’s doula? Why, when a homebirth transport comes in, do the women still think they have a right to force us to adhere to an unrealistic and sometimes absurd birth plan? (I know you all certainly wonder) Why do women listen to midwives – women with far less education and experience than we have? How can women implicitly trust a woman with no license or a license that isn’t even nationally recognized or accepted? What do they say to get women to be so militant against doctors, hospitals and medicine?

The answer?

Nothing.

Hospitals and doctors make their own beds with their actions and words.

I understand there is very little to be gained on the economic front and that is not your motivation. I understand your heart-felt concern is for the life and health of the mother and baby. I understand that you feel any inconvenience should be tolerated and the “birth experience” is ancillary to the final outcome.

But, you see, the hospital “experience” is abhorrent to many women. When the experience includes procedures, medications and a dismissal of a woman’s individuality, the risk of being at home doesn’t seem so great after all. When women describe their hospital birth experiences in terms of “birth trauma,” “birth abuse,” and “birthrape,” something is terribly wrong with the system.

It is the hospital system itself that writes the homebirth script. If you want women to stop having homebirths, you are going to have to make some major changes in how you operate. I firmly believe if the hospital and physician care weren’t so egregiously offensive, cruel and inhumane, the Unassisted Childbirth (UC) movement wouldn’t be accelerating.

It is in the typical birthing experience in our country that sends women away from medical care and into the hands of homebirth midwives or planning UCs.

If I were on the committee to re-vamp the hospital system, being blunt with ACOG and the AMA, these would be my recommendations:

1. Stop de-personalizing women by putting them all in hideous hospital gowns.

I know you are probably rolling your eyes, but women HATE those gowns and understand that whatever they wear (of their own clothes) will be tossed into the garbage after the birth. Removing personal articles from women is tantamount to institutionalizing her. It’s vulgar.

2. Stop calling women “Momma,” “Mom,” “Mother,” and use her name.

It is rude at best to diminish a woman to a universally used word instead of acknowledging her individuality by remembering her name, not just the vagina, in front of you.

3. Since birth plans are so similar, perhaps listening to what the majority of them ask for would be prudent.

You know the drill… no continuous monitoring, encouraged (not just “allowed”) to ambulate in labor, encouraged to eat and drink in labor (and not assume every woman is headed to the operating room), no routine IV (most women are cool with a saline lock)… and how about bringing in birth balls, huge tubs and the accoutrements that homebirths and even in-hospital birth centers provide. If LMs, CPMs, CNMs and CMs can learn to maneuver around water labors, ambulating women and women on hands and knees, then surely educated physicians such as yourselves can.

4. Stop offering medications when women ask for them not to be mentioned.

We all know medications and epidurals are an inch away; we don’t need to be asked, “Where is your pain on a scale of 1 to 10?”. Women who want a natural birth work hard to not think of labor as pain. Again, if women in the hospital want something for pain, they darn well know they can ask for it. It is extremely disrespectful to a woman’s desire to re-frame her perception of pain in labor, all this Pain Scale stuff.

5. Educate nurses and yourselves about the importance of reverence in labor and birth.

Speak softly, knock before entering the room, look in a woman’s eyes, SLOW DOWN, listen when she speaks and THINK before you do; stop when she asks you to stop (touching her, the vaginal exam, lying to her, etc.). While this might be the 20th baby you’ve “delivered” today, it is that woman’s ONLY birth that day… perhaps the only baby she will ever have.

On the same note, when you are the surgeons during cesareans, SHUT UP about day-to-day topics and remember where you are – standing at the birth of a human being. Imagine the doctors and nurses yacking about the best sushi restaurant of the moment while your daughter (or spouse or mother) is taking her last breaths on earth. That is exactly what it feels like to many women when you act like you are cutting on an anesthetized woman. This woman lying there feels – perhaps not the skin incision; her heart and spirit are not numbed. The same respect and consideration are due humans joining the earth as humans leaving the earth.

6. Stop using your status as a means to manipulate or lie to women when they ask you questions.

Educated women are so tired of “the dead baby card.” There are times when life and death occur, but there is an enormous leap between, “We need to rupture your membranes so we can put an electrode on the baby or your baby might die,” and an abruption. Your exaggerations and attempts at –or out and out manifestations of- risks must stop. I believe the manipulations are one of the major reasons women ignore what obstetricians (and many nurses) say. If you always spoke the truth, your word would stand stronger. Crying wolf takes on a whole new meaning with physicians in the baby business. Nowhere else in medicine can you find this level of untruth streaming towards patients.

Just today a woman told me about her two mild decelerations in an eight-hour period that caused a doctor to take the husband outside and say the over-used phrase, “If she were my wife….” The doctor insisted on an “emergency cesarean,” yet the woman didn’t find herself in the operating room for another 4.5 hours. Interestingly, her surgery was at 5:00 pm. Coincidence? We are sure not. How can you wonder why she wants an out-of-hospital birth this time? Such absurd scenarios pepper your medical records; we see it all the time. Stop it.

7. Find a way to open your hearts to the pain and sadness in women whose births don’t go the way they expected.

Of course women “shouldn’t” have a cement-set vision of their births, but many women do have desires and wishes and it is deeply sad for them when things turn out differently. Try and talk to her like a human being in pain, not just a physical body that can be repaired with staples and numbed with Vicodin.

I understand your belief in the impossibility of seeing each woman as a human being. I understand you think if you hear every woman’s fears, pains and concerns you will surely commit suicide from all the pain foisted upon you. I understand that you think you just don’t have the time for all that emotional stuff. I understand that you believe listening is for a therapist, not a technician like a doctor. I understand you are busy, busy and just can’t possibly have any more time to offer women so they can whine and cry about this or that.

But, you are wrong.

The best and most beloved of doctors touch their clients… if not physically (although many do this as well), then emotionally. They take a few extra moments to listen to women, not just hear them. Re-frame your own perceptions of women speaking about sad, painful or difficult topics. It isn’t whining; she is speaking from her heart.

The great part of all of this, though, is that when you open yourself to a woman’s pain, you also have given her the space to share her joys, laughter and triumphs. It isn’t all negative “energy” that comes from pregnant, birthing and postpartum women. It is a mix of emotions, just as life is a mix of joy and sadness.

Through exquisite sadness comes exquisite joy.

8. Demand more (compassionately-trained) nursing staff in Labor & Delivery units.

Women know one reason they are encouraged to have epidurals is to keep them immobilized and quiet. (Did you know that?) It is much easier to staff a unit with women who don’t wander the halls or moan with each contraction. We know it can be disconcerting to watch women give birth without medication, especially when you believe women are suffering needlessly. But, one reason women choose midwives is we are able to BE with women in their transitory state of labor towards becoming a mother (or mother again). Being able to not just tolerate, but embrace an unmedicated woman’s labor is a wonderful gift of understanding and kindness to women. It’s okay if she’s loud. If she “scares the other women,” take the lead and explain the wonder of an unmedicated labor and birth to the frightened patient. People reflect the emotion you express, so express goodness instead of disgust or dismay when speaking to other patients regarding unmedicated laboring women. And really, if it’s so distressing to everyone, sound-proof the rooms; technology abounds.

Have nursing staff attend doula trainings to develop the compassion necessary for work in L&D units. Seeing birth from another angle can do nothing but expand her capabilities with unmedicated and medicated women alike.

9. Institute doulas in all L&Ds.

When the above goals are met, doulas become the physical and emotional augmentation for nurses in the unit. If the woman no longer has to hire a doula to fend off the medical interventions, she becomes what she was designed to be… the loving support person for the laboring couple.

10. Remember that birth is unpredictable.

You chose to be obstetricians. Birth happens during the entire 24 hour day and night. If you are one of the many that “nudges” women to birth during the daylight hours, whether with pitocin or cesareans, shame on you! If you are tired, either suck it up or find more help in your practice. If you are on-call, sit yourself at the hospital for your call time. Coming and going, wooshing in at the last second of birth, discussing a woman’s care via telephone and forcing women to stop pushing until you arrive are incredibly insensitive and sometimes cruel ways to treat a woman birthing a human being. Probably the number one complaint I hear about obstetricians is their absence in birth. Women are shocked at how little they see their doctor – any doctor - once in labor. A major reason women hire midwives is because they are physically present for labor, birth and postpartum. A nurse is not a replacement for your care. If you feel labor sitting is beneath your skills and a waste of your time, perhaps losing the OB portion of your title is called for. Women pay for your care. Isn’t it time you care?

11. Accept that as long as the System remains the way it is, women will continue having home and unassisted births.

There will always be a segment of society that desires homebirths and it behooves the medical world to do what it can to make the emergency transition from home to hospital palatable. While hearing “We want you to see we aren’t monsters in the hospital” when a woman moves from home to your L&D units is less than comforting, the sentiment behind it offers a moment of understanding in why some people choose homebirths in the first place. If all of you really want us homebirth advocates to not see you as monsters, quit acting like ones!

None of the above requests include anything about the prenatal and postpartum period. Often, your prenatal demeanor belittles a woman’s questions and concerns. It isn’t uncommon for your appointments to last mere moments after the multi-hour’d waits in the waiting and exam rooms. Calling a woman by her name and looking her in the eyes as you speak goes miles towards building trust and goodwill. Women who trust sue less. If there is no other motivation to humanize your demeanor, consider that studied fact; women who know their doctor well typically do not take them to court.

One reason midwives are rarely sued by the client, much to your bafflement, is exactly because communication between midwife and client is so extensive. Communication builds trust and trust allows the care provider to say, “We really need to do a cesarean,” and the client/patient saying, “Okay.” I know it sounds simplistic… and it is really that simple.

Risk is a part of life and those that choose homebirth are accepting that risk. Women don’t just want an “experience,” they want compassion, respect, some semblance of autonomy and the knowledge they are being seen as an individual, obtaining individualized care. It might seem selfish or bizarre that someone would take that risk, but it seems a risk to step into the hospital and be put on the production line that includes unwanted (and often unneeded) medications that are used to speed up the production line, being pressured to immobilize and be silenced and strong-arming that all too often ends in a cesarean.

While it seems I am only focusing on what you all need to do, I also know homebirth midwives could always use more education. The schools work hard, and are working harder, to include the vital information that keeps a woman safe at home and to know when a transfer/transport are necessary long before it gets to the critical stage. Midwives don’t wait until the last second; we understand the time element that can be crucial in life and death.

A glaring error in your Resolution says that CPMs are “lay midwives.” That is incorrect. A lay midwife has no formal education in midwifery, but only learns through apprenticeship or even on her own, rarely studies birth as is done now. It is rare to find a lay midwife, even in states where there is no licensing. In California, the National Association of Registered Midwives (NARM) exam (which, if passed, creates a CPM credential) is accepted by the Medical Board of California as the bar women must leap over in order to be licensed in the state. The same can be said for other states that have adopted the NARM exam as acceptable for licensing. Licensed and Certified Professional Midwives are not lay midwives. Using that sort of inflammatory language leaves the homebirth/natural birth advocates shaking their heads knowing you still don’t understand even the basics of what women want or need. I am the first to say licensed and CPM midwives’ education doesn’t equal a certified nurse midwives’, but we do have book learning, CPMs now graduating from accredited schools. We also have experience in natural birth and in knowing normal birth, we are hyper-aware of when birth deviates from the norm.

Another issue I have with your Resolution is your acceptance of out-of-hospital births with CNMs. Do you not know we carry the same equipment and medications (except for sedatives and an isolette) as what sits inside a free-standing birth center? Once again, having all the correct information before writing public pronouncements would help your image amongst those that have issues with you.

Instead of bashing midwives, wanting to outlaw homebirth and perpetuate half-(or un-) truths, understand we aren’t going anywhere and it might better serve women and babies if you supervised us (as CA law requires) or at least collaborated with us. Talk to your insurance carrier, create a resolution that you cannot be sued when patients transfer care from a midwife without taking that fact into account, find a way to tolerate (at least!) midwives so the relationship doesn’t have to be so antagonistic. We’ll also do our part in continuing to educate ourselves, create increased opportunities to practice vital skills and work towards licensing in all 50 states.

I know this is long, but I hope it’s been at least somewhat enlightening. Please consider the requests above. They will fast forward the goals you desire - to have more women birth in the hospital; the location we all know is the absolute physically safest place to have a baby. Physiologically, probably not. Interpreting the difference is paramount.

Wednesday
Jun112008

One Dose of Antibiotics...

...can prevent postpartum pain and infection in 3rd and 4th degree tears (and episiotomies?).

A combined Stanford University, Packard Children's Hospital and Santa Clara Medical Center study shows that one dose of intravenous antibiotics can greatly reduce the infection or breakdown of tissue that can cause repurcussions such as bowel incontinence and sexual dysfunction.

"The researchers found that four of 49 patients (8.2 percent) treated with antibiotics and 14 of 58 patients (24.1 percent) who received the placebo showed symptoms of infection or breakdown two weeks after the repair."

The study is thought to transform the postpartum regimen for women with the deeper of the tears that can occur through birthing.

Because we all want to avoid antibiotics as much as possible, lets hope this doesn't just change the actions of physicians, but also women who will find ways to minimize tearing - including not pushing while the staff hollers to 10 (Val Salva/purple pushing), positioning that doesn't have a woman on her back with her legs in stirrups and keeping the providers' hands OFF the perineum as the baby is being born.

Wishful thinking, probably, but one can hope, right?

Sunday
Apr132008

Tristan's Birth - 1982

In all the talk about birth today and its challenges, I thought a reminder of the past in hospital birth was in order. It doesn't mean there still isn't much further to go, but I know, from being there, that we have, indeed, come pretty darn far.

Below, this first picture demonstrates the normal birth position in 1982 - lithotomy. While it is hard to see me in the blue drapes, my head is at 4:00 from the light in the mirror. You can see my legs spread on either side of a bunch of cloth (that I don't know what it is!). You can barely see the stirrup my right leg is resting on at 5:00 from the light. You can also see the oxygen mask on my face.

My former partner is taking the picture from beside my head. You can kind of see him to the left of my head, leaning in with the camera in his hand.

To see the birth, I had to lift my head and look in the mirror. Even without an epidural (which wasn't even an option at the time), it was like watching a movie, seeing Tristan born. I was given a mediolateral episiotomy (an epis that went sideways into my thigh muscle) and couldn't really feel him coming out at all.

I had been shaved and given an enema in the labor room. Back then, there was a labor room, the delivery room, the recovery room and the postpartum room... being moved each time a new part of the birth occurred. I was in a progressive hospital that gave each woman her own labor room; the other hospitals in the area and around the country had between 2 and 4 women in each labor room. Once I went to Germany, they had 2 women per labor room in those military hospitals.

I had demerol at 3 centimeters and 4 centimeters, but had no other pain medication after that. Epidurals were unheard of for several more years (in my birth and doula experiences), that wasn't even an option. I was pre-eclamptic and had magnesium sulphate for the duration of my pitocin induced labor (because I had rupture of membranes and no contractions for TWO HOURS!).
This next picture is what the doctors looked like at the time. In fact, everyone had masks on in the room except me, but I did have that O2 mask. There weren't Universal Precautions at the time - HIV/AIDS was barely known then - so there isn't the plastic that we know now. Those are cloth gowns - unheard of now! And the metal you see in the bottom right of the picture is the thingie that keeps the drapes from getting in the way of my vagina and in the "sterile field."

I wasn't tied down, but was told to keep my hands in the straps or they would have to use them to keep my hands away from the sterile field.

It's a boy!

Babies were born, the cord cut and immediately taken to the warmer where the nurse did the Apgars, wiped the baby off and swaddled them. The delivery room was flippin' freezing!

See all the blood on the doctor's right hand? That was from my episiotomy bleeding.

Also, note the warmer. It is a stand-alone warmer with a "bassinet" tucked inside the legs with the heaters up at the top. I don't see these anymore, but loved them when I had a client who wanted to "bond" with her baby. The warmer could hover over the client's recovery bed, keeping both mom and baby warm so the baby didn't have to go to the nursery. Moms also shivered a lot less, which, we know now, can increase bleeding. When I had Aimee, I had one of these warmers over us and it was great. We needed the signed permission of the Neonatologist and Head Nurse of the Newborn Nursery in order to keep Aimee with me immediately postpartum. (This was in 1986.) The order of the day for births a little longer than that was taking the baby to the nursery right away for 2 to 4 hours, depending on protocol.

The nurse spending the first few minutes with my son. She has a mask on, but no gloves (!!). He was observed for a few minutes under the warmer while I was sutured and right before leaving the Delivery Room, I got to hold Tristan for about 30 seconds.

Read part 2 here.

Sunday
Apr132008

Tristan's Birth - 1982 (con't)

Read part 1 here.

Look, no gloves! Is that the most amazing thing to imagine?


Me holding my baby boy. Tristan Ian was 9 pounds 4 ounces and 23 inches long. Born October 20, 1982.

Notice my fat nose and puffy eyes. Classic PIH/Pre-eclampsia signs. Can you see my fingernails? Eek! They were at least an inch and a half long!

I had a roomate, only one, which was unusual at the time in that area. I got special treatment because my former husband and his mom worked at the hospital. I was also given loads of peanut butter cookies every day. (When is help not help?)

Tristan, a week old. We were visiting my Nana who was in a nursing home. Nana was my great-grandmother, Tristan's great-great-grandmother.

But, look what I am wearing! And I am breastfeeding. How did I think I was going to nurse in this tight dress? I didn't think about it and ended up nursing him on the toilet with my dress all pulled up and tucked under my neck.

It was also extremely painful to sit or stand because of the episiotomy. I wasn't pain-free until about 7 weeks postpartum and still feel the scar decades later.

Aren't my glasses the best? They are the size of dinner plates! How 1980's! And my "wings." laughing I still wear bangle bracelets. Have always loved them.

Well, there's a quick trip through the History of Childbirth from one woman's experience. Interesting, eh?

If it weren't for Tristan's birth... and then my Unassisted Birth of Meghann 19 months later... I would never have known I was supposed to be a midwife. Still in the dark after Tristan's birth, I thought it was so wonderful I wrote a thank-you letter to the doctor, nurses and president of the hospital! Can you imagine? After a mediolateral episiotomy! shaking head

 

Do you have a story from the early 80's or before? Do you have a blog? Tell your stories!

Wednesday
Dec122007

Montage World!

Dear Pamela (Sage Femme) put up a beautiful montage that is making the rounds. Go see it here!

Quick to follow something good (great!), I have already done one montage myself and would love to share it with y'all. Regular readers have already seen several of the pictures, but I did add more to complete the visual story.

Click below - let me know what you think!

Look forward to more montages - and soon - videos on YouTube since I just got myself a little Flip (a black one). It's the coolest! A mere $120 at Costco (regularly $180!).

('Cuz I don't have enough to do! laugh)

Sunday
Aug192007

Let's Critique a Birth Plan

Since writing this blog piece, the author of the birth plan removed it from public view, so reading the complete plan is no longer possible. Because it was originally published publicly, I've chosen to leave the post as it stands. I will, however, remove the link to the original post. It seems the author might not have been quite ready to have the birth plan shared with the Internet when the search engines picked it up (I received two alerts from two separate search engines), but she left the birth plan up for 4 days before making it private.

I commented on her own blog, thanking her very much for the great learning opportunity she was offering. I continue believing this was a great object lesson for many of us - from childbirth educators, birth book authors, and student midwives to pregnant families, doulas and anyone else who works in the childbirth field I've not mentioned by name.

I thank her for sharing, even if it wasn't intentional.

BIRTH PLAN: WATER BIRTH USING HYPNOBIRTHING

So, I encourage you to go read the whole birth plan first and then I will take parts of it and critique it here. Why are we going to do this exercise? We've talked about this before... remember? Birth plans shouldn't be longer than a 3x5 card long. That's a start. This birth plan, which came across my email as a Google Alert ("Natural Birth") is ripe for using as an educational tool for childbirth educators, doulas and student midwives.

Shall we? (I'll put the birth plan's words in green.)

In advance we thank all our healthcare providers for their skilled care and kind support. We have tremendous gratitude for your assistance and know that during our labor and birth we may not be able to verbalize or show our appreciation. We have tremendous respect for our care providers and want you to know that while we have very specific requests for our birthing experience, that if need be we will always listen to and consider medical advise if a medically emergent situation should arise for mom or baby. Thank you for helping this to be a truly beautiful, natural, once in a life time experience for our family.

Too wordy! Instead of my saying this 8000 times, suffice it to say this birth plan is far, far, FAR too wordy. It behooves the hospital client to remember their nurse almost always has at least 2 and usually 3 patients to attend to at the same time. Reading something this long would be nearly impossible to do.

"It is not only that we want to bring about an easy labor without risking injury to the mother or the child; we must go further. We must understand that childbirth is fundamentally a spiritual, as well as a physical achievement...The birth of a child is the ultimate perfection of human love" - Grantley Dick Read

A quote? Egads. Do not waste space on a birth plan with a quote.

All natural birth has a purpose and a plan; who would think of tearing open the chrysalis as the butterfly is emerging? Who would break the shell to pull the chick out?

This could almost be seen as insulting to the hospital staff. Of course, we natural birthing people see it as right and beautiful, but (many of us feel) the majority of hospital maternity workers tear open the chrysalis long before the butterfly is even ready to emerge... and anesthetizes her during the experience as well. I'd just as soon see this quaint quote left out. They will just roll their eyes at the person who puts it in their birth plan.

The patience and understanding of medical caregivers to refrain from any practice or procedure that could unnecessarily stand in the way of our having the most natural birth possible.

Quiet room, dim lights, our chosen music. We also ask that Dawn not be engaged in conversation and that caregivers converse between each other outside of the room, unless addressing a emergent situation. If permission is needed for a emergent medical procedure please keep discussion brief, with a respectful quiet tone, addressing both mom and dad.

Please open and close door to labor room quietly, with respect for mothers privacy and concentration.

Bullet points should be used. Throughout the entire birth plan, there are typos... two being found in the last line above. It should read: Please open and close door to labor room quietly with respect for mother's privacy and concentraction. Actually, if I were their doula, I would encourage their making a sign to put on the door that said, "OPEN DOOR SOFTLY!" and that would be the end of that bullet point right there.

Please refrain from using terms such as "pain", "hurt", "intense", "hard labor" or making any suggestion of pain being experienced. Please do not offer pain medication at any time. Please do not ask the strength or scale of contractions.

I would bet that in 95% of circumstances, they will say, "I know you don't want me to say anything about pain, but I have to ask just once. Where on a scale of 1 to 10 is your pain right now?" Nurses hardly talk to patients who have support people except during admission... at least until they are pushing, so it isn't that big of a deal, this asking them not to mention words of pain. I also believe that just your saying these words on a birth plan... your telling them not say these things is asking for them to say them over and over again. To think is to create.

Many of this birth plan's requirements are negative for the care providers - against what they normally do - and when they are shoved out of their comfort zone (when any of us is), they can make it miserable for the patient demanding these changes. And, in my experience, they go out of their way to make things miserable for the birthing family... purposefully annoying them with small or large things they specifically asked the nursing staff not to do.

Minimal vaginal exams and only with permission. My preference is to have one cervical check upon a completed admission EFM that supports evidence of strong, active labor to establish dilation and a second cervical check at suspect of reaching full dilation, if needed to advise Dr. Rollins.

This is a strange request altogether... more like a couple of them rolled together into one bullet point. Minimal vaginal exams in and of itself, of course is a terrific request. But, instead of putting it on a piece of paper, when they come at you with a gloved hand, just keep your legs closed and say, "No."

I request my bag of water to stay intact and for it to rupture spontaneously with no assist.

Wellllllll... ya gotta keep people's hands outta your vagina if you don't want your membranes to "accidentally" break.

Minimal EFM after initial admission strip, unless medically emergent. No saline lock or IV unless medically necessary. Blood pressure and doppler tones to be taken minimally without breaking mothers concentration with conversation or brisk activity. No blood draws unless medically emergent and with permission only.

Interesting choice of words... saying "unless medically emergent." It isn't uncommon for the hospital staff to say things are medically necessary (I don't think I've ever heard the term "emergent" used) and to find a way to convince a laboring couple within a few moments why something should be done when initially they thought they would never ever ever think they would consider having it done. BE CAREFUL SAYING "NO" to something.

And this birth plan is rife with "with permission only." Well, permission is granted already upon admission when the papers are signed. Someone needs to educate this couple of that because they look foolish otherwise. It's birth plans like this that make (many) nurses snicker behind those attempting natural childbirths' back - mostly because the person writing the plan is simply ignorant, not stupid.

I request to eat light snacks and drink tea, juices, water and 7-up during labor.

You can request it all you want, but if your doctor or hospital refuse it, you are screwed. Some people are finding it is best to just eat quietly (when no [medical] one is in the room). Instead of you requesting it and putting it on your birth plan, discuss it with your physician and have him/her put it on your standing orders at the hospital! That's the best of all ideas.

To allow labor to take its natural course without reference to "moving things along".

Why are you having a hospital birth? Please read my When You Buy the Hospital Ticket You Go for the Hospital Ride blog piece. The deeper this birth plan goes, the more controlling it gets. How does this person really expect a hospital to not utilize the standard tools to click a labor along? Do they really believe they will let someone labor for 3 days without concern that the hospital administrators and lawyers wouldn't have met to ask the doctor what his game plan is and why he hasn't done a cesarean already? Push for 6 hours without having the doctor's head spin off its spindle as he worries about what he'll say up on the witness stand because the presumption will be the baby will have some serious postpartum recovery issues? While the healthy and alive mother and baby are utmost, EVERYTHING IS DONE WITH THE COURTROOM LOOMING AS THE BACKDROP OF THE LABOR & DELIVERY SUITE! To expect your wishes of an unhindered birth to occur in a hospital is absurd.

I repeat:

To expect your wishes of an unhindered birth to occur in a hospital is absurd.

(I almost just want to stop here.)

No augmentation of labor via Pitocin or stripping of membranes.

Don't say "No." laughing How's that for negative talking? Saying "no" to something gives it an enormous amount of energy. Stripping of membranes in a labor and delivery suite? That isn't even something that is done and makes the author sound ignorant.

I'm sitting here thinking, "You could say, 'Use of pitocin after discussion' or 'Use of pitocin only when warranted," but they believe that's the only time they use pitocin! They don't feel they use pit randomly; so it's just silly to try and say to them to only use it when it's necessary.

The use of a birthing ball if one is available and the freedom of choice to walk and change positions as needed. The freedom to use the floor to find comfortable laboring positions.

Do you KNOW what's on a hospital floor?!? BLECH!!!!!!!!!! (Apparently, according to a commenter, some women do get on the floor with covers and sterile drapes. That seems more appropriate - covered sounds great.)

To allow natural bithing instincts to facilitate the descent of the baby, with mother directed breathing down until baby crowns. Use of hypnobirthing breathing techniques during birth of baby...no Lamaze promts please. Perineal counter pressure if needed to slow the birth of babies head.

Typos in Red. This is all in one bullet point! Please proof and correct typos before giving your birth plan to anyone. Or putting it on the Internet.

Or putting your comments on someone's blog. (Sorry, I couldn't resist.)

It should read:

To allow natural birthing instincts to facilitate the descent of the baby with mother-directed "breathing down" (I would add "of the baby") until the baby crowns. Use of Hypnobirthing (technically, that should be capitalized, but I didn't want to get out the red pen again) breathing techniques during the birth of the baby... no Lamaze prompts, please. Perineal counterpressure if needed to slow the birth of baby's head.

Please do not shine bright lights toward baby during birth, keep lights as dim as possible during labor and birth.

? ? ? ? ?

Even if lights are kept dim, lights will be shined onto your perineum and that is where the baby comes out, so the baby will have lights shined on him/her during the birth. (Unless your care provider doesn't use lights during the birth as a few care providers do not use, including Dr. Wonderful and a commenter.)

I ask once again. Why is this person birthing in the hospital?

Please allow 30-45 minutes for natural delivery of placenta with No pitocin administered, No manual removal, No cord traction.

You can't see my eyes bugging out, can you? Now, I've learned from all the smacks upside my head not to say "You will NEVER see..." but I would LOVE to hear from someone who has seen a placenta be allowed/permitted to be naturally born taking 30-45 minutes in a hospital while the care providers waited and watched with their hands in their laps. I'm trying hard not to laugh at how absurd that even sounds coming out my fingers! As if that could ever, ever happen. Anyone?

(Well, a commenter, Dr. Jen, a great Family Doc came foward and said she has waited 30 minutes for placentas before, so there you have it. I am speechless - and delightedly so! Good for you, Dr. Jen! If she is one, she can't be alone. Thank goodness! So, perhaps the birth plan writer isn't so odd after all? But, I would suspect - in the majority of cases - this request is unrealistic. I would suspect Dr. Jen would agree. Yes?)

Did this person who wrote this birth plan discuss this with their care provider and the doctor say, "Sure! Put that in your birth plan!" Or was it just a wish plan they just decided to write and believe the hospital would follow. I believe it was the latter (but am not 100% sure).

(I am really glad that Dr. Jen uses a birth plan as a spring board and I would love to see more care providers do so - and listen to clients do that!)

Oral vitamin K to be used. No injections for baby. If boy - no circumcision.

Unless you have prepared for it, hospitals don't typically have oral vitamin K... do they? Is that something new they are doing? Or would they look at someone asking for that as if they were also asking for the pharmacy to make their placenta into capsules.

No injections for the baby. At all? Under no circumstances? What if the baby is sick? Has hypoglycemia? There are caveats all through the birth plan. This is one place a caveat might be a good idea. And putting circumcision in a birth plan is bordering on bizarre. Circumcision does not occur in birth anymore - and hasn't for a LONG, LONG time. If you want the nursing staff to roll their eyes at you but good, putting a note about circumcision in your birth plan is certainly the way to do it.

No PKU testing, heel prick, or blood draw for baby.

Again, if the baby is ill, then the baby is going to be poked. That's just the way it goes. And PKU (officially called Newborn Screening) testing is done on the second day or so postpartum... this is also not a birth plan point.

No use of Erythromycin or any eye salve to allow optimal sight for bonding.

Eye salve? What is eye salve? Where did that come from? Choose your words very carefully when writing something like a birth plan. The last thing you want is the staff laughing or rolling their eyes at your choices or your hard work.

Please place a blanket or chux on scale prior to weighing.

Does anyone not?

I've just learned so much from listening to nurses discuss Birth Plans over all these years and it is so much better to set your stage before you ever set foot into the hospital than to expect the birth plan to make your whole experience Nirvana.

And haven't we heard women speak about their birth plans being ignored (or sabotaged) enough to know that long involved speeches get us nowhere? And might even get us sent to Hospital Hell?

I vote for families who want convoluted birth plans to:

1. Have a home birth

OR

2. Have a birth center birth

OR

3. Have a CNM in the hospital

OR

4. Find a Dr. Wonderful

OR

5. Get your ducks in a row BEFORE labor begins so you don't have to fight once you are in labor.

AND

6. Hire a doula to help you with your support and care, but NOT to speak for you.

Comments?

Wednesday
Aug152007

A Birth Unfolds in Photos & Words

Needing to change to a hospital birth late in pregnancy, my client was able to change to Dr. Wonderful who works at one of the two Baby-Friendly hospitals in our city. His promise to help her have a marvelous natural birth in the hospital wasn't bullshit; his words are Truth.

This first picture, however, demonstrates what occurred when mom was admitted to the hospital. The baby's baseline fetal heart tones were about 100, albeit somewhat reactive. FHTs during the pregnancy were 140's-150's, so 100's were somewhat disconcerting. Dr. Wonderful was called in.

This photo shows mom's sister laying on hands and giving loving energy. Mom is talking to the baby, letting her know she is safe and all is well... dad, as we can see, is concerned, but hanging in there. Mom has oxygen on her and technology all around.


The (wonderful, amazing) nurse (we had) did a vaginal exam and found mom to be 3 cm. The nurse and I began preparing mom for a cesarean - physically and emotionally. I explained the cesarean procedure, the epidural... and the nurse said the anesthesiologist would do a spinal because the spinal would be faster... and I explained things to dad, tried to get his garb for him to put on, but we were busy getting consents signed and all. Waiting for the doctor seemed endless. Fetal heart tones were dipping into the 90's and not getting any higher than 110 with accelerations. I kept calm, but was clear and sharp with the information.

My dear doctor was on the phone at the nurse's station when I went out to go ask his ETA and our nurse said, "Do you want to talk to him?" and I emphatically said, "YES!" before the other nurse hung up and said he was on his way in.

Dr. Wonderful floated into the room like a silk scarf on perfumed air, filled with more confidence and hope than I carried - more like a midwife than I was at that moment.

He did a vaginal exam and immediately, the baby's heart rate jumped to 148! She loved his touch on her head. Oh, and how I did, too. Mom had also progressed to 6 cm. in the last 30 minutes. Amazing!

Tears fell from my eyes as I watched the baby's heart rate settle back down into the low 100's (90's/100's) and the doctor suggested taking a whiff of oxygen every few minutes when she felt like it instead of keeping it on all the time like she had been. He also told her she didn't have to lie on her left side... to move wherever she wanted to - oh, how she wanted to be on her hands and knees! He said the baby was just low, having a vagal response and there was no need for a cesarean at all.

And me, thinking he needed a scalpel. How precipitous I would have been as a surgeon! Thank the goddess it wasn't me making that decision.

The entire labor, my client was extremely vocal, so much so that at one point, the people next door banged on the wall, presumedly to make her be quiet. She, so high in her Laborland (her word), made passing notice, "What's that?" - not, "Oh, am I too loud?" I was so friggin' amused, I joined her howls, getting even louder than her for a few contractions lest she be worried at all about the sounds (she wasn't). No nurse came in to tell her/us to be quiet - that she was scaring the other women or that she was using all her energy in the wrong way or anything. She just howled her baby on down. Yummy!

And so mom moves onto her hands and knees... squats at times, rocks at times... even once jumped up onto her haunches from hands and knees!

I love, Love, LOVE this photo. It speaks of the beauty a hospital birth can actually attain when given a chance with the right doctors, nurses and hospital. And supportive midwife as doula.

smile

Because we thought she would need a cesarean, we had mom take off her gorgeous Hawaiian dress and mom was then naked. The great nurse handed mom a hospital gown once mom knew she was going to stay laboring in that room and she promptly took the gown, put it in front of her and puked all over it. I thought I was going to pee in my pants from laughing so hard. No one ever offered her another gown.


Dr. Wonderful and Nurse Fantastic are seen below with mom as she feels her baby's head as it descends into her vagina. The doctor is on her left side, on the bed; the nurse, kneeling on the floor. Most of the time, I was where the nurse was, but occassionally moved to take photos. Notice that mom's belts have been removed... this is easily many, many minutes before the birth. We/I held the monitor to her belly instead of her having to contend with the strap at the end. I held the monitor on her belly for most of labor so she was able to move around, too. I much prefer hand cramps to a mom's immobilization.

Mom had a couple of exams. The nurse asked to do an exam when mom had an urge to push, but I discouraged it, so she went away. When mom thought she was pushing, I asked her to feel for herself and she felt for the head and it was, indeed there. I couldn't see (my head was down under her, lying on the bed), so Dr. Wonderful just rested his hand on her perineum for one second and said, "Yup, baby's right there," and removed his hand.


I was inches away from mom's perineum as the baby was coming towards the earth and this was the last photo right before Dr. Wonderful put his hands in the way and covered the head as the baby was being born. (I'm going to have to speak to him about that!) This series of minute forward motion head shots is so incredible because I can see the capillaries stretching/breaking in mom's vulva as the head descends. Who knew all that happened!

The baby girl, tightly squeezing out... her head had been suffused, so her body is quite white. The doctor does have gloves on, but they are surgical gloves, so it almost looks like he doesn't have any on at all. He is not pulling her at all, but allowing her to come out all on her own. He is very gentle on "his" babies... allowing them to do their own thing and never pulling on them. In fact, I was more concerned about a stuck shoulder than he was. He smiled at me when I put the camera down and asked if he needed help. I'm laughing at how funny that must have sounded to him now, but at the time - and how accessible he is to me - it doesn't sound absurd at all. He just smiled and the baby came out nice and slow... slipping out roll by roll by roll... all 8 pounds 8 ounces of her.

Before the baby was born, the nurse came up to me and asked, "Does mom and dad want Vitamin K and Erythromin for the baby?" and I answered they did not and thanks for asking. She didn't bat an eye and nothing more was said about it. When things got closer, I let mom and dad know things had already been covered regarding the baby. They were glad they didn't have to do it. Me, too! How cool to have a nurse come to me, eh?

Because the baby had a tight squeeze and because there was a goodly sized caput, I was wondering if the baby might not need Vitamin K after all. Dr. Wonderful checked the baby over and said, "Nahhhh, she's fine."

blink

Do you see the doctor in this picture? He's the one not in scrubs. The one in the yellow shirt.

Dad wasn't sure about catching, was going to help me catch when we were having a homebirth, but wasn't so sure about it at the hospital. Once there, though, I'd talked him into helping the doc and even had him practice washing his hands with the fancy foot soap and water thingie at the sink. Once the doctor was there, though, he was more nervous, but as things got closer, I put my midwife voice on and said, "You will only birth this child ONE TIME, so I HIGHLY suggest..." and that was as far as I needed to go before he jumped up and washed his hands and got ready to help the doc catch his baby.

The picture below is the beautiful photo of dad (who does NOT have gloves on, thank goodness!) assisting Dr. Wonderful with his newborn daughter.


In 24 years and 8 months of assisting women in birth in the hospital, I have never seen a woman birth on hands and knees. I've never seen an OB or a CNM allow a woman to birth in the hands and knees position. I have never seen an OB do a vaginal exam on a woman in any position except on her back until this birth when this doctor did a vaginal exam with mom on her hands and knees. I actually wondered if he could even find her vagina with her on her hands and knees! He didn't have any problems at all. Shocking. I think I've seen a CNM do a vaginal exam on a woman in an "alternative" position maybe 20 times in all these years, so even that is a sad commentary. I tell women I can find their vagina or fetal heart tones if they are hanging from chandeliers! How did I get so good at it? PRACTICE!

Anyway, so here my client has her baby on her hands and knees... her husband helps the doc catch and it is amazingly wonderful, but now mom needs to see her new daughter. How does that happen?

In most hospital worlds (as if any of the above would have happened in the first place), the cord would be cut, mom would be flipped over, the bed would be broken, mom would have her feet placed in the stirrups so she could have her vagina checked and she'd get her baby that way.

Instead, Dr. Wonderful, who's not wearing scrubs and only a pair of surgical gloves, doesn't cut the cord and knows how important it is to just give mom her kidlet says, "Okay, mom... here comes your daughter... ready?" And then passes her between her legs.

I love, Love, LOVE that I have this picture! There won't be many times in my life that I will have a photo such as this. This is a DOCTOR (I know, I shouldn't be shocked anymore, should I? But I am. I am mostly shocked that I am blessed to be in the same room and photographing such an awe-inspiring event that brings hope to hospital birth everywhere).

Nothing needs to be said about a mother's love. This picture is my desktop right now. I think this is one of the best pictures I have ever done showing a mother and child. I get shivers just looking at it! The shadows are perfect, the lights... the IV... all of it... her daughter isn't even 3 minutes old in this picture.

I end the series with a tender surprise photo I took of Dr. Wonderful with my client. He embraced her, then she him. He with tears in his eyes and both of them whispering thanks to each other.

To have witnessed the cruelty and evil of so many other (un)care providers in over two decades of birth work, I splash in the absolute pleasure of experiencing birth in a hospital with my guard down, not worrying about saving my client from having her birth plan ripped to shreds or having her baby taken from her by Child Protective Services for being one of "those" mothers. There's always so much to watch out for in the hospital... we all have to be Cerberus to feel safe (and even that isn't nearly enough, now is it?).

So, it just seemed so important to demonstrate how it CAN be. It might not be for anyone else in the world but this one mom - or the moms who get this one amazing doctor - but if this one man can exist, then there is hope in hospital birth. It doesn't mean hospital birth replaces homebirth at all. My client needed to birth in the hospital for a very serious reason and she was so amazingly gracious about moving to the hospital to deliver there. So, if some women do have to deliver in the hospital... isn't it a good thing to have hope?

I live for hope.

Baby Madeline Joyous was born August 12, 2007 at 2:41 am after 6 hours of labor.

She is gorgeous!

(more pics of the baby to come when I take some)

Monday
Jun252007

Garden Laboring

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

 

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

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

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

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

Sunday
Jun242007

VBAC Success!

Story to come...

BUT, this will be one of the most amazing and glorious stories EVER that I have told.

Highlights:

- Mom labored, walking outside in a garden with continuous monitoring almost the entire labor.

- Dr. Wonderful stayed with us and talked and laughed and told stories almost the entire time.

- The cesarean doctor said the mom's pelvis would never be able to "tolerate" a baby coming through it. She birthed a posterior baby this time (Direct OP delivery).

- Mom had a Saline Lock - that's it.

- We had a nurse to ourselves who was so wonderful - except for one time when she was infuriating - and I'll tell you about that, too. (How come we had to have that one time when she was infuriating? She was glorious the rest of the time!!)

- Mom did not have any pitocin shot into her postpartum.

- I got to take care of the baby on mom's belly immediately postpartum, ensuring the baby was treated gently and respectfully.

- The doctor wanted the family to be able to use their iPod in the room so went and bought an iPod docking station.

- I was able to discuss things with the doctor when the family was having alone time in the garden that will make my practice infinitely easier, safer and more incredible for myself and my clients. I am floating today about the VBAC and my experience with the birth and my discussions with the doctor!

Who knew birth could be like this in the hospital?!?

Wheeeeeeeeeeeeeeeee!!!!!!!!!!!!!!!!!