Monday, August 30, 2010

Preparing for Unassisted Birth

This information is compiled from various sources for informational purposes only.  If you or someone you know is preparing for a possible unassisted birth, this should not be your only information source.

Rather than post a list of necessary items, I'll give some guidelines.  There are very few truly necessary things for birth, and you can generally make do with what you already have at home.  

For instance, one mother had an unexpected home birth with no supplies:  

They had just moved and most of their things were still in storage when she unexpectedly went into labor three weeks before the due date.  All they really had was a t-shirt to wrap the baby in after it was born, and they used thread to tie the cord and scissors from a first-aid kit to cut it.

Someone I know had a similar experience:

They were planning a hospital birth, but the mother had a very fast labor (40 minutes) and the baby was born in the bathroom before the father had even arrived home to help.  She had called him home from work and he got there after the baby was born and helped deliver the placenta.  He used a shoelace to tie off the umbilical cord, and kid scissors to cut it.

Unplanned home birth carries more risks compared to planned home birth.  Some women have a history of fast labor, and there are times they just don't make it to the hospital or the midwife doesn't get to their home in time for the birth itself.  In these cases it may be a good idea to plan for a possible unassisted birth in case things go so quickly that the preferred plans don't work out.

The first and most important piece of advice:  Have faith.  Trust in your body's ability to birth this baby.  In his book "Childbirth Without Fear" Dr. Grantly Dick-Read states that 95% of births can safely take place without any intervention.  This means the odds are in your favor to safely birth your baby without help.

"I like to tell my clients to remember their grandmothers and other female ancestors. Since the beginning of time, the women in her bloodline have given birth successfully, otherwise she, herself, would not be here having a baby." - Melissa Chappell, Doula

Follow your body and do what instinctively feels right.  Don't try to analyze anything, just let your mind go into the primal state that it will naturally go to if you let it.

Dr. Gregory White has a book about birth for fire fighters and police officers, in case they get a 911 call to a birth.  It's a step-by-step guide that tells how to catch a baby.  Dr. White says "any normal 8 year-old can do this."  If you have an older child or partner who can help, you can prepare yourself and them by reading this book.

Check for a nuchal cord: When the baby's head is out, slip your index finger in to feel for the cord.  If there is a cord around the neck the baby may be able to "birth through the cord" or do a somersault as the head stays close to the mom's body.  If the cord is very tight you may have to flex the baby's head and slip the cord over it.  Very rarely do you need to cut the cord and unravel it before the rest of the body is birthed.

What if the head is out, but the body is taking a while?  The body generally slides out soon after the head, and usually comes out with one push.  If it seems to be taking a long time, the baby's shoulder may be caught on the pelvic bone.  True shoulder dystocia is rare, but generally simple to handle.  Just get up on your hands and knees, and it will help shift the baby's position and allow the rest of the body to come out easily.  If this doesn't help, then you can reach in with your finger and gently pull the shoulder toward the baby's chest and release it.

What do I do when the baby is out?  After you or a support person has caught the baby, simply bring the baby up to your torso.  The placenta will still be inside, and the baby will still be attached to it by the umbilical cord.  There is no need to cut the cord before the placenta is out.  

How do I help the baby breathe?  Most babies can expel the remaining amniotic fluid from their lungs by simply spitting it out.  You can help your infant do this by holding the baby face down with your hand supporting the tummy.  If you're concerned that it may not be coming out fast enough you can use your own mouth over the baby's mouth and nose to gently suck out the fluid.  Suck, spit, suck, spit, etc.  The baby may cry a bit once the fluid is out, which is a good indication of breathing.  If you have a bulb syringe, you can use it to suction the fluid out, but this isn't as gentle as the other methods described.  Always remember to suction the mouth first, and then the nose.  It may help you remember this by remembering that M comes before N in the alphabet.

How do I keep the baby warm?  The easiest way to do this is by keeping the baby against your warm skin, and place a towel or blanket over the baby and yourself.  Breastfeeding is an excellent way to keep the baby warm and happy.

How do I help the placenta come out?  You may or may not feel contractions after the baby is out.  Do not pull on the cord.  This can cause fragments of the placenta to be left inside, leading to hemorrhage, or some cords may snap when pulled.  You can help the placenta come out by squatting.  Allow the baby to breastfeed, and this will help the uterus contract effectively to birth the placenta. 

When should I cut the cord?  After the placenta is out you can wait for the cord to stop pulsating before cutting it.  You can use anything clean to tie off the cord.  Braided embroidery thread or string, or a shoelace will work just fine.  There's no need to tie it off in two places.  Simple tie the cord close to the baby's belly button and cut it on the side of the thread away from the baby.  You can even choose to leave the cord intact and simply wrap the placenta in a towel or chux pad and place it near your baby's feet.  The cord will naturally detach within a few days to a week.  Leaving the cord attached is known as Lotus Birth, and you may research this option beforehand.

How do I know if I'm bleeding too much?  Blood loss is completely normal after birth, so don't worry when you see blood.  It's also normal to see blood clots come out with the placenta or afterward.  Trust your feelings more than your brain, as how you feel will be a good indication of how well you are doing after the birth.  You can drink cinnamon tea to help prevent hemorrhage.  Most people have cinnamon in their spice rack, and you can add 1 tsp of cinnamon per cup of water.  2 1/2 cups of blood loss or more is considered hemorrhage, but it can be tricky knowing how much blood you've actually lost.  You may choose to prepare yourself by doing tests prior to the birth:

Put different amounts of water mixed with catsup and pour it on pads, or towels on the floor, or in the bath tub.  Squirt catsup as fake clots.  Always measure before pouring so you can get a good idea of what that amount looks like after it's been spilled.  This will give you a visual indication of how much is too much.

You can even eat a small portion of the placenta as an effective way of preventing or treating hemorrhage.  One way to do this is by making a placenta smoothie.  Midwives in Hawaii use this, and it's recommended to add 1 tsp of placenta to 8 ozs of juice.  Red juices work best, such as cherry or tomato.  Just mix it in the blender and drink.

If you or the baby seem unwell in any way, do not hesitate to call for help.  Most of all, trust your instincts.  If you and the baby are both well, just let the natural endorphins take over and enjoy the memory of your amazing birth and your new little bundle!

What did you think of this?  Do you have anything to add that might be helpful?

Saturday, August 28, 2010

The Longest Weekend of My Life: Preface

This is the first post in a special Saturday series.  Please check back next Saturday for Part 2.

Part 1: Preface

My husband and I wanted another baby, but we'd been planning to wait a few years. The last two kids were born pretty close together, and with 5 kids we definitely felt we had our hands full. We probably would have decided to stop having babies by now if we hadn't been strongly impressed that there's another little girl who is waiting to come to our family. In spite of all logical arguments, we planned to have another baby... just not yet.

We've learned with the last few pregnancies that our plans don't always work out the way we think they will. God often has a different plan or schedule in mind, and that usually trumps anything we've got in mind.

We absolutely love our big family, and we wouldn't trade that for all the riches in the world, and yet I found myself worried about what other people will think if they knew we were planning to have a 6th child. I'd even told myself that when I finally got pregnant again I wouldn't say a word to anyone, because I'd been afraid of the comments I might get. All I wanted was for our friends and family to support us, tell us congratulations and wish the best for us, but with each subsequent pregnancy it seemed they were less and less excited for us. With each pregnancy, as we strived to depend on the Lord for guidance more and more in our lives, we'd been both apprehensive and excited at the same time. With the last few being surprises it took a little while for the reality of the situation to sink in, but once it did it seemed like we couldn't stop smiling, and we got very excited to have another little one in our family.

Babies are precious, and they bring a light with them that nothing else in the world can compare with. I really like this quote from Larry Barretto:

"Babies are bits of star-dust blown from the hand of God. Lucky the woman who knows the pangs of birth for she has held a star."

When I was personally attacked online for having a big family I was told I should “stop having babies and find a new hobby”. This was from an anonymous person who apparently was very worried about global overpopulation and planned to never give birth to her own offspring. After recovering from the initial shock, I realized it wasn't a personal attack afterall, and I had simply fallen between the cross hairs of this jaded individual.

In my polite response to the anonymous attacker, I quoted Liz Armbruster:

"I brought children into this dark world because it needed the light that only a child can bring."

How can you NOT bring children into this world? When you've known the incomprehensible joy and love that comes with nurturing and growing a developing fetus in your womb and then birthing it peacefully as a newborn babe into your arms, how could you even think this isn't a miracle? Children are a wonderful, blessed gift from God, and I feel honored to have been blessed with so many beautiful babies.

Lo, children are an heritage of the Lord: and the fruit of the womb is his reward. - Psalms 127:3

I'd been learning Fertility Awareness after our 5th child was born. I felt strongly a few years back that I shouldn't take hormonal birth control any longer, and I'd been pushed to find a more natural way of approaching family planning. I know some people who don't use any form of family planning as they pray and trust that God will give them what is right for their family. I felt I needed something to help me plan. I am a planner, afterall, and it gave me peace feeling I was doing something positive for my family.

I had a few odd cycles as my body adjusted back to normalcy after my baby's birth. A couple of my cycles had been about 45 days long, while one had been only 21 days long. So I didn't think much about it when my expected period didn't come. I decided instead of worrying I'd wait it out and see what my body was doing. I wasn't feeling emotionally ready to be pregnant again with my baby only a year old. Afterall, my husband had decided 3 years would be a good gap and I had agreed and supported him in that decision. This is where we always seemed to learn the Lord has other plans for us. 

Part 2: Bittersweet
Part 3: Numb
Part 4: Peace
Part 5: Waiting
Part 6: Writing and Reading
Part 7: Decisions

Friday, August 27, 2010

Planning and Meditating on Birth - Part 2

If you missed Part 1, click here to read it.

There is no magic recipe for a perfect birth. 

We have ingredients, or options, and each of us is in charge of writing the recipe that's best for us.  Why must we write our own? Why can't we just take an existing recipe and hope for the best? The Feminist Breeder writes on her blog why she won't leave her births up to chance. When you follow someone else's plan without serious consideration you are essentially leaving everything up to chance. I've done it myself, twice. Sometimes this works and things still turn out OK, as it did for me. You survive and your baby survives... oh, but I've gone over this already.

1. The first thing to do is become an informed consumer.  I've talked about this many times. It's one of the main reasons I have this blog. I believe every expectant parent should do their research and become an informed consumer. Know your rights and your options, and know that you are the one in charge. As a consumer everyone else serves to please you. Doctors, nurses, midwives, doulas, hospitals, birth centers, clinics... ALL of them are there to serve you. They have training and expertise in their various specialties, and can act as consultants in helping you make choices. Their place is not to dictate what will happen or make choices for you. Uninformed consumers must have choices made for them. It's your choice who will control your baby's birth.

How do you know if your birth will be like mine, better off at home away from medical intervention and unnecessary surgery, or like the other mother I mentioned whose baby needed to be in the hospital where he could get the immediate care he needed?

2.  Assess your feelings and follow where they lead you.  Ultimately you must make a choice, based on both knowledge and your personal feelings. Some people have paralyzing fear of hospitals and doctors and would be most comfortable elsewhere. Others have paralyzing fear of NOT being in the hospital where there is ready access to all the medical technology you could ask for. Whether that's a good thing or a bad thing is really up to you. I have an almost paralyzing fear of surgery, and I would do anything in my power to prevent an unnecessary surgery. That fear definitely plays into the decisions I make for birth, and so far it has served me well. Even if you don't have a paralyzing fear of anything, you will likely have some kind of feeling that will help guide you in the right direction.

3. Honor yourself and tune out the outside noise.  Pregnancy is a time when unsolicited advice seems to come at you from every direction. Whether you want it or not, everyone seems to know what they think is best for you and your baby. Everyone has a story to tell, and they love to tell it. Whether you plan to go to the hospital or have your baby at home or in a birthing center, someone will always have a horror story or opinion to tell you.

I was due to have my fourth baby in January. A very nice lady at church asked me about my due date and I told her that I was focusing on getting through the holidays and then I would feel ready to have my baby. She told me about her daughter who wasn't due until January, but the baby came unexpectedly a month early and she had nothing ready for Christmas. It may have seemed like a harmless story to her, but it stressed me out!

Hypnobabies teaches women to use a "bubble of peace" to help them stay connected with their own feelings and not allow outside advice or stories to upset their emotional balance. Essentially, you imagine a bubble that surrounds your body and keeps in all the happy, good feelings and blocks out all the unwanted stuff that invades you from other people. This is a good way to stay focused on your own feelings, whatever they may be. If there is fear within you then address that fear. Figure out where it's coming from and whether it's valid. Is there anything you can do to allay that fear? Do you have any control over what you're afraid of? If you have control over it, then take care of it. If it's beyond your control then you've done what you can and you can let it go.  Understanding the truth about power and control may help you be able to let go of what you can't control.

4. Continue to check in.  If there's a persistent nagging concern or fear that you just can't shake, then take it seriously and consider changing your plans. Just like the mother I met who never felt comfortable planning a home birth, there could be something you're unaware of that needs you to make a different choice.

In my case, I prayed. I felt I should consider home birth, even though I'd never considered it before. I felt peace about it, and peace as I chose my midwife and moved forward with my plans. I didn't ever feel a need to change my plans, and I never felt the need to prepare for a possible transfer to the hospital. Even as the due date approached, my midwife prayed about who to ask to provide support at the birth, and a specific person came to her mind. That person was a midwife with extensive vaginal breech experience. I feel God knew my baby would be breech, even though none of us did, and He helped me to prepare for it all along the way. I was blessed, I feel, because I knew my options. I had learned as much as I could and then I followed my feelings. I was blessed to avoid surgery which would likely have been traumatic for me. I had the desired experience and the desired outcome, without having to choose between the two.

Wednesday, August 25, 2010

Planning and Meditating on Birth - Part 1

I was talking with my sister recently about birth choices, and I started wondering how much the decision of where to labor and give birth has an impact on the experience and the outcome. I told my sister that if I'd been in the hospital with my breech baby I probably still would have had the outcome of a healthy baby, but the experience would've been altogether different. The labor itself would have been different and I wouldn't have been so relaxed and comfortable. And then there's the issue of the surprise breech, which would have led to an emergency cesarean. Instead of recovering from a vaginal birth at home, I would have been recovering from abdominal surgery with 4 small children and a newborn. My fear of c-sections in general would have left me scarred emotionally, and I would've had a lot more to heal from than just the physical trauma from the surgery. I also would have ended up with a uterine scar that could impact future births.

I shared my home breech birth story with a group of my midwife's clients at her home. At the very same meeting another mother shared her hospital birth story, and it was a striking contrast to mine. She had a natural labor without interventions in the hospital and everything went smoothly. However, after the birth she noticed her baby was twitching. The doctors and nurses hadn't noticed it. It took the mother's eye and intuition to see that something was wrong. They determined that the baby had suffered a stroke sometime after the birth. Because they were in the hospital, the infant was able to immediately receive the medical care he needed. What was even more interesting to me was when she told us that she had considered planning a home birth, but whenever she thought about it she felt uneasy. She didn't know why she felt uneasy, but she followed her feelings and planned to have the baby in the hospital. She was exactly where she needed to be, and it was because she followed her feelings. I, on the other hand, had felt nothing but peace when I planned my home birth, and I was exactly where I needed to be.

I believe there are times when no matter which choice we make, we'll still have a positive outcome. Almost all babies would survive whether they were born at home or in the hospital, whether born vaginally or by c-section. Almost all mothers will survive birth regardless of where it takes place or under what circumstances. But the outcome is not the whole picture.

Rixa from Stand and Deliver has a great commentary post on her blog about the way people say that all that matters is a healthy mom and baby. "Health" in this sense usually means "alive".  

We all know that health is all-encompassing, and it doesn't simply imply survival alone. Health is physical, mental and emotional. When a woman has a traumatic birth experience under any circumstances, she is emotionally unhealthy. Trauma can lead to Post Traumatic Stress Disorder, and while it's not commonly associated with postpartum women, if the mother suffered trauma during the birth she is more prone to this state of disease. Trauma is not associated with specific birth events, but rather the woman's interpretation of them and her feelings of either being in control and respected or being out of control and disrespected. By definition the CDC considers cesarean section a "morbidity", which would imply that any woman who's recently had a c-section is physically unhealthy. We can see that there are many different situations under which a mother and baby can survive birth but still be unhealthy afterward.  Heather Armstrong wrote a beautiful, yet heart-wrenching post on The Unnecesarean about her own experiences with emotional and physical trauma regarding birth.

The outcome matters. The experience matters. The emotional, mental and physical well-being of mother and baby matter. How can expectant parents plan for birth with all of these variables in mind? How can they make decisions about their baby's upcoming birth hoping for the best experience and the best outcomes?  

Click here for part 2...

Monday, August 23, 2010

Obesity and Cesarean Section

A recent blog post on The Unnecesarean sheds some light on the connection between obesity and cesarean section:

The post is partly in response to a New York Times article:

The Unnecesarean post also cites a really good blog post on The Well-Rounded Mama:

For a nice overview of the topic, read the post on The Unncesarean, and if you want more info, read the other two as well.

In a nutshell, this is what I learned:

  • Obese women are more likely to have a cesarean because of the increased risk of pregnancy complications like Gestational Diabetes and Pregnancy Induced Hypertension (AKA Preeclampsia).  How much?
  • According to The Well-Rounded Mama, 90% of obese women will NOT experience GD or PIH.  The risk for GD in morbidly obese women (BMI over 35) is 9.5%, compared to 2.3% in women with a BMI less than 30.  The risk for PIH in morbidly obese women is 6.3% compared to 2.1%.

Jill from The Unncesarean also points out that these aren't the only reasons obese women are more likely to have a c-section compared to other women, and that journalists should write about the reasons and heart of the matter rather than simply sensationalizing the trends.

I personally have a hard time seeing how these complication risks can warrant the current US overall cesarean rate of 33%.  Something to think about.

Saturday, August 21, 2010

Diantha's Crossing

This is a film about a midwife in the mid-1800's.  I was deeply touched by the story, and I thought I'd share it.

If for any reason the video doesn't load, you can watch it here.

Friday, August 20, 2010

Understanding Posterior Babies

In celebration of the OP baby

I found this amazing blog post all about posterior babies, written by a midwife.  It has lots of visuals and explains why babies are posterior and what it means for labor and birth.  I especially appreciate her perspective of posterior position being a variation of normal birth rather than a problem.

Wednesday, August 18, 2010

Don't Give Me No Lip!

I recently had a request for a post about cervical lips.  I realized it's not something I've posted about before, and it's not something that people usually discuss about birth.  It's actually fairly common, so it's a good thing to be aware of.

A woman can be almost fully dilated but still have a portion of cervix blocking the baby's head from coming down.  This is often referred to as a "cervical lip".  It's detected by the doctor, midwife, or nurse by doing a vaginal exam during labor.  Because this happens near complete dilation, the laboring woman may feel a strong urge to push.

"If your cervix still has a thickened area (sometimes called a 'lip' or 'anterior lip'), you may need to avoid bearing down altogether until the cervix dilates completely.  Otherwise, the cervix may swell and slow labor progress."* 

I experienced this during my home birth.  I was dilated to a 9, almost complete, with a little bit of cervix in the way.  My midwife told me she would let me do a test push in a little bit and she left the room to talk with her attendant.  Anxious to have my baby, I started to consciously bear down, only a few times.  When my midwife returned to check my progress she found that my cervix had swelled and hardened, and I was now only dilated to a 7.  It took a few hours for my body to dilate to complete again after that.  I had no idea at the time that my little pushes could set my labor back so much.

When I was once again almost complete my midwife told me there was an anterior lip, and this time I listened to her and waited for the lip to clear when she told me to go ahead and start pushing.

"Your nurse or caregiver will guide you in what to do at this time.  Although it is sometimes very difficult and uncomfortable to keep from pushing when you have a strong urge, it is not harmful to postpone pushing until the cervix has completely dilated."*

Some caregivers will help by holding the lip with their fingers during a contraction, to try and push it out of the way.  They may also instruct you in how to breathe through the urge to push to help you be able to wait as the cervix dilates the rest of the way.

Cervical lips are not dangerous.  They're simply a part of the birth process, and it happens to many women in labor.  Knowing about this can help you experience labor and birth with more understanding and confidence in your body's ability to give birth.

***UPDATE:  Some care givers don't consider a cervical lip to be of any concern whatsoever and will allow the laboring woman to simply follow her body's urges and push when she feels like pushing.  The approach to a cervical lip can really depend on the care giver and his or her general approach to labor and birth***

*"Pregnancy, Childbirth, and the Newborn", by Simkin, Whalley, & Keppler, p. 199

Monday, August 16, 2010

Advocating For Evidence-Based Health Care

This includes maternity care, but it's much bigger than that.  The Consumers United for Evidence-Based Healthcare (CUE) is a group that helps educate and advocate for improve healthcare in the US.

‎"We’re only going to get evidence-based healthcare in this country through consumer activism." 

-Kay Dickerson, director of Consumers United for Evidence-Based Healthcare.

Friday, August 13, 2010

Video Depiction of The History of Childbirth

I first saw these video clips on The Unnecesarean.  Each segment is part of a video entitled The Timeless Way: A History of Birth from Ancient to Modern Times.  It was released in 1998, and it's a fantastic depiction of birth through the centuries.  I think it should be included in every childbirth education course.  It takes about 20 minutes to watch all 5 segments. The images are stunning.  I hope you enjoy it as much as I did!

Part 1: Birth Images from Ancient Times

Part 2: European Birth Images from the 1500's

Part 3: Birth Images from the 1800's

Part 4: Changes in Birth Practices

Part 5: Consequences of Modern Birth Practices

Wednesday, August 11, 2010

"a baby story tlc dr vaginal breech"

I have this tracking widget installed on my blog that I can check whenever I want to.  It's a live feed that shows roughly the last 50 hits on my blog.  It's pretty nifty, and it shows me where each hit comes from (usually just a regional area), which browser and operating system they use, whether they were arriving to or leaving from my blog, and how long ago it was.  One of my favorite features is that it shows how someone got to my blog, whether it was through a link on another site, a direct entry, or through an internet search.  

I like looking specifically at the phrases that people search for which lead them to my blog.  For instance, I get a lot of searches for "postpartum binding" or similar verbage.  I'm a little embarrassed to admit that page gets more hits compared to any other page on my blog.  I think it's sad, and an indication of the world in which we live, that the majority of the people online are searching for something related to body image rather than something like "intrahepatic cholestasis in pregnancy" or "hellp syndrome", or even something as simple as "benefits and risks of epidural".  Yes, I do get the occasional hit on those topics, but not as often as I'd like.  I guess I just expect people to be as interested in all of these pregnancy-related topics as I am, and it surprises me that I don't see more searches for what I consider to be the more weighty issues that pregnancy and birth involve.

Once in a while I come across a really interesting search phrase.  One which makes me wish I could somehow track down that person who searched for it and have a really good conversation with him or her.  For instance, someone recently found my blog by searching the phrase "a baby story tlc dr vaginal breech".  Sadly the search engine directed the person to this page, probably because the post title included the first 4 words in the search phrase.  That's not so bad, but it would have been really nice if, instead, the person could have been directed to any number of my blog posts regarding breech babies: Breech Resources: Turning a Breech Baby, Breech Baby,  Thinking Out Loud Re: Breech Babies, Breech Presentation: Risks and Options,  among others.  I'll just blame the search engine for not reading my mind on where to send people!  

At any rate, the reason I wish I could speak with this person is twofold: 

  1. I would like to explain that he or she would be hard-pressed to find any episode of TLC's A Baby Story which shows a vaginal breech birth with a doctor, or any vaginal breech birth for that matter.  I've never seen one yet, and I have watched that show more times than I probably should admit to.
  2. I'd really just love to sit down and talk about breech babies with this person, and share my own beautiful story of my vaginal breech home birth.  There has got to be a reason this person was looking for footage of a vaginal breech birth, and whatever that reason is I wish I could be of more help than what a silly search engine provides.  At least if someone searches for that phrase now, it will bring them here.
Here's a tip for anyone that uses search engines to find blog posts.  Blogger, and many other blogs have a search function at the top of the page.  If the page your search brings you to doesn't match what you're looking for, try using the internal search function to do a search within that blog itself and see if something more relevant comes up.  Happy reading!

Monday, August 9, 2010

Darcel's Story - Samuel's Birth at Home

by Darcel

Let me start by saying we went back and forth on deciding if we wanted to have a freebirth or not.  I had researched it since I was pregnant with Ava, and wanted to with her, but Charles wasn't feeling that idea at all. He thought I was crazy for wanting a homebirth.  After Ava's birth and the months,years to follow we talked more about freebirth.  I asked him if he was comfortable this time around, and he was hesitant at first, but then came around. We were going to go ahead with the freebirth this time, and then I changed my mind and wanted to see a midwife. 

Samuel's birth story starts a week before my EDD(estimated due date). Around May 7th or 8th.  I had not seen my midwife since March. I loved seeing her apprentices. They were the ones who did all of my prenatal appointments anyway. The midwife missed my 36 week home visit, but her apprentices came out. I was upset that she missed my appointment. I talked it over with Charles and thought of dropping her then.  When she missed my 2nd home visit, I was done. I was 38 weeks, and had not seen or heard from her in months!  She had not called to check on me, didn't apologize for missing my home visits, nothing. 

Charles and I talked over the idea of having a freebirth once again.  The apprentices helped me find another midwife if we chose to go that route.  They knew that we were comfortable with having a freebirth.  We didn't think it would hurt to have a midwife attend if we changed our minds. 

For all of this craziness to happen when I could give birth at any moment was very stressful for me.  I had prodromal labor for about 3 days.  It was hard for me to deal with. I had trouble sleeping, because I would wake up during the night with contractions, and then I would wonder if this was the day.  I was becoming exhausted, no sleep, contractions off and on during the day and night, taking care of the girls.  I started to feel really drained physically, and emotionally.
One night I cried to Charles about how tired I was, and I felt ready to be done.  I wanted the contractions to either produce a baby, or stop completely because I couldn't take it anymore.

A friend suggested I do what worked for her with both of her kids.  A walk on the beach, a nice big meal, and nipple stimulation. The next day we took the girls to the beach. I had a couple of contractions on our walk to the beach from the boardwalk. I had a few contractions once we left the beach. Those contractions felt different from the braxton hicks I was having. I didn't think anything of it.  We came home and Charles went back out to get Chipotle. I LOVE their burritos.  After a few hours I started contracting again, and asked Charles to get the birthball for me.  I sat at the computer, tweeting, checking email, eating more of my burrito, and timing contractions.  The contractions were any where from 5-10mins apart, and lasting for 45 seconds to over 60 seconds.

I still didn't think I was really in labor. I went to bed a little after midnight, and kept waking up with more contractions. I needed Charles to rub my back through them, and I had to get on my hands and knees to deal with them.  I was back and forth to the bathroom, back in bed, sleep, contractions, back to sleep.  Looking back, I woke up to several contractions that I had to moan through.  We decided to move downstairs to the couch around 3-4am.  I sat at the computer on the birthball again, but kept leaning across the birthball with more contractions.  I was feeling them really low in my belly, and in my back now. I also kept going to the bathroom to pee after every couple of contractions. Sitting on the toilet made them feel worse, so I didn't sit there any longer than I had to. 

I decided to join Charles on the couch, but after a few contractions and not being able to get up fast enough to lean across the birthball, I decided sitting on the birthball would be best.  Charles would wake up and rub my back through the contractions, and then he would lie back across the couch to sleep.  That was fine with me. I needed him to be as rested as possible.  I tried  to watch an episode of The Young & The Restless that I had recorded.  At this point, it still didn't hit me that I was really in labor.  It wasn't until I started to feel like I needed more support. That was around 6am.
I told him it wasn't that his support wasn't enough, I just feel like I wanted midwives to be there.  He suggested I give it another hour to see how I felt, and I agreed. My dad was up getting ready for work, and we thought of sending him on, but I quickly changed my mind in a matter of minutes.

In case your wondering, I'm still not convinced that I'm going to have my baby soon.  I was beyond being in denial, extremely exhausted, or both!

Around 6:30am I was needing to do the slow dance with Charles to work through the contractions. I kept telling myself that I wasn't in pain, they weren't painful, it was pressure, and it would pass. With each contraction I pictured the ocean, and the waves coming in and going back out. It helped that we were at the beach the day before, and I could hear the sound of the ocean in my head.  I decided it was time to call the midwives. They were so awesome, and they were close by since they had attended a couple of other births hours before mine.  I'm not sure what time it was when they arrived, but the contractions were becoming more intense, and I still had to pee after them.  I asked about getting in the pool, but it wasn't with them. They had left it with another mom the night before.  Charles suggested he run some bath water for me, and I couldn't wait to get in it.  Part of me didn't want him to go because I was leaning on him during the contractions. 

Once the tub was ready he helped me walk up the steps to the tub. I had a contraction on the steps and leaned on him while he rubbed my back. We checked in on the girls quickly before walking down the hall to the bathroom.  The water felt so good, and really helped with the contractions. Charles stayed upstairs with me, and the midwives stayed downstairs.  I got to the point where I just stretched out across the tub, and had one of my arms hanging out of it.  At this point I was moaning quite loudly through the contractions, and started to feel like I couldn't go on anymore. Using low tones and the letter O.  That helped me to think of my body opening and the baby moving down.  I was beyond exhausted. I told Charles that I couldn't do it anymore, and I was so tired. He rubbed my back, and told me he knew I was wiped out, but that he knew I could do it. I was on the verge of tears. Not because I was in pain, but my body felt like it was done. I wanted to sleep. 

I told him it was different with Ava, because I wasn't laboring for three days beforehand. I kept insisting that I couldn't do it anymore, and I wanted to go to the hospital. I felt so exhausted that I told myself I didn't care if I had the epidural, or if I had a cesarean, I just wanted to be done. Then I thought to myself that an epidural wouldn't be good because of all the risks and complications that go along with it, and I didn't want a cesarean because of the recovery time, and that could also pose risks to me and the baby. I didn't know what I wanted to do. At this point I felt like I was seeing stars, and couldn't even think straight.  He kept encouraging me that I could do it, no matter how tired I was, and that I was doing it. }  He kept telling me I was doing great, but I didn't believe him.  I asked him to have the midwives come upstairs, and he thought that was a good idea too. 

They came into the bathroom, and I lost it at that point. I started crying, saying I was done and couldn't do it anymore. The contractions were becoming more intense and they suggested that I might want to get on my hands and knees so that my belly was in the water. I stayed in that position for I don't know how long.  Charles went to check on the girls, one of the midwives stayed with me to apply counter pressure to my back, the other one went to get the birthpool.  Charles turned on the shower head and put it on the massage setting so the water would be more forceful on my back.  After a while I decided I was ready to get out of the tub, and I moved to the bed. I asked the midwife to check me. I just had to know where I was, and where the baby was sitting.  She checked me and I was 9cm! I let out a big "Thank you Jesus!" and felt really silly and a little upset with myself for not recognizing that I was in transition, and that's why I felt like giving up.

The midwife said the bag of waters was bulging, and baby was still up pretty high.  She thought the bag of waters might have been what was dilating me. She thought that once my water broke the baby would come down pretty quick.
The other midwife returned with the pool. and I asked them to set it up downstairs.  The girls were still asleep, which was amazing to me because I was moaning like crazy through the contractions now.  Once they woke up, we told them the baby would be here soon. Nakiah went to sit with my dad in his room, and Ava laughed hysterically when I had a contraction. Apparently she thought the sounds I was making were hilarious.  The pool was up, but they couldn't hook it up to the hot water tank.  So they used the kitchen sink, but the adapter still wasn't working correctly.

They told me the pool was ready, but it wasn't full. I didn't care. I was ready to get in and that was all that mattered.  Charles helped me down the steps, and I had a contraction on my way down.  I looked at the clock and it was after 9am.  He helped me into the pool, and the water was so warm and I was able to relax for a few minutes. I put my head back, closed my eyes and drifted off for a few minutes.  Charles had made some recordings for me. The ocean, a rainforest  of birds, and sounds of the Amazon.  The sounds helped me to concentrate on something else, and they were very relaxing, nice sounds to fall asleep to.  I didn't know he made that for me until right then. I had talked about how I thought having music or sounds would be nice to listen to while I was in labor.

When I woke up I felt this pressure in my bottom, and said I felt like I had to poop.  The midwives asked me not to push yet because the baby was still up high. They said I could push if I really wanted to, but I agreed with them that if I could wait until my body started to push on it's own, then that would be best.  With each contraction after that I would moan and blow. They told me I would have a contraction, sleep for 10mins, and then have another contraction. They said it was awesome that my body gave me rest like that right before the big moment. Usually contractions are right on top of each other at the end.   That's how it was with Ava. So thank you body for giving me rest when I truly needed it!
Charles said you could tell the baby was moving down, because the shape of my belly started to change.  After a while I got on my hands and knees again, and Charles and the midwives took turns applying the counter pressure to my back.

Ava would come down and play for a bit. She would check on me and go back upstairs.  Nakiah wanted nothing to do with what was going on at the time. She stayed upstairs, hanging out with my dad.

With the last contraction I remember, I couldn't blow anymore. I yelled "I can't stop, the baby is coming!"  My water finally broke right then!  I was leaning over the tub, holding onto Charles. He was taking pictures and video. I heard one of the midwives ask him if he wanted to catch his baby. She said she would let him know when the head started to crown.  I could feel my body pushing, and the baby coming down. I let out this massive roar....I've never heard that sound come out of me before.

Later my dad told me the girls looked at him when they heard that, and he told them the baby was coming.

The midwife told Charles it was time. I could feel him crowning, and they told me to blow. I started blowing because I didn't want to tear. After his head was out, I gave one last push and Charles said his arm and then the rest of his body came sliding out.  I heard Charles yell "I got my boy!" I started smiling and laughing. I turned over and they handed him to me. I couldn't believe how tiny he was compared to the girls.  The midwives said he was definitely ready to come. He didn't have much vernix on him at all. Some on his head.  I'm so glad I waited until my body started pushing! It was less than two minutes, and he was out.  He took in some water on his way out. I guess I had raised up out of the pool a bit when his head was coming out.A small part of his forehead came out, and that was enough for him to think to take a breath.  I talked to him, we rubbed him to stimulate him, and then the midwife suctioned him a bit.  He started to pink up, and we continued talking to him, rubbing him, and he latched on to nurse within minutes.

Charles went upstairs to get my dad and the girls. Nakiah said she was being shy and didn't want to see him yet. Ava couldn't wait to see the baby. Ava touched his head and said "it's on me!" and wiped her finger off on Charles.  I snuggled with him in the pool for a bit longer, waiting to see if the placenta would come.  After a while we got out of the pool, and not long after the placenta came out all by itself.  It was a tiny placenta compared to the girls.

They helped me upstairs and into bed. Samuel's cord was still attached. After his newborn exam, Charles cut his cord and weighed him. We still can't believe we had a 7lb baby.  Even though this was my most intense birth, it was still an amazing and empowering experience.  There you have it. The story of how Samuel Royce-Alexander came into the world on. May 21st 10:20am 7lbs 10oz.  He's two weeks old now, and we're loving every minute with him. I call him our little Prince.

Friday, August 6, 2010

High Tech vs High Touch

I found a really great post at the Midwife Next Door: "Thank you for touching me": the conflict between high-tech and high touch care.

I didn't realize that many prenatal care providers don't use touch anymore in the care they give to expecting women. Most care providers these days use ultrasound to check for fetal heart tones, fetal position, size, and overall well-being. Did you know that there's a technique care providers can use that's called Leopold's Maneuver that can check all of these things, and they only need to use their hands?

My obstetrician, his nurse-practitioner, and my midwife all use Leopold's Maneuver. I didn't have more than one ultrasound in each pregnancy, because my care provider was able to determine the baby's well-being with their hands. Not only was it extremely simple and helpful, but it's also comforting to have high touch care like that. I definitely prefer it over the cold jelly and hard probe of the ultrasound machine.

There is some question about the safety of ultrasounds. We don't know how safe ultrasonography is on a developing fetus, as no long-term studies have been done. Ultrasound machines are not regulated, and the wave frequency has not been tested for safety. We don't have any evidence against it, but we also have no evidence to support its routine use during pregnancy. Ultrasounds in the last trimester of pregnancy are also unreliable in determining a baby's size. The estimation can be off by a full pound, more or less. With these questions in mind, wouldn't you prefer to use a proven hands-on technique rather than an unproven technology?

I'll leave you with an excerpt from the post by the Midwife Next Door:

"Women in labor need hands-on care. It’s known that women who have a female birth companion with them during labor have fewer c-sections and faster births, with fewer epidurals needed. Why is this? I believe it’s because a machine can never replace a human, even if it is more accurate in certain assessments. A machine may be able to tell me that this woman is only 3 centimeters dilated, but my eyes and ears tell me that she looks and acts as if she’s in transition, and guess what? Most of the time, my eyes and ears don’t lie, and we have a baby within the hour.

"In our push to improve birth outcomes, we continue to move farther away from the hands-on, low-tech models of countries with exemplary birth statistics, such as the Netherlands, England, and other countries where midwife-attended births are the norm. Instead of looking for new machines to meet this goal, why not look to the example of cultures who are working within the midwifery model of care that is already meeting this goal?"

Wednesday, August 4, 2010

A Father's Perspective on Doulas

My Experience With a Doula During Childbirth
by Dana H. Glazer
As published on Huffington Post

After writing last week about a father's role in the birthing room, it occurred to me that I would be remiss not to address my own personal experience in the delivery room as you might find it surprising and perhaps even helpful.

Like many dads, I attended birthing class with my wife, watched videos and even read a book or two on the subject of birth. However, studying for the experience and being in the frontlines of a birth are, of course, two different things; and as prepared as I tried to be for the occasion, I thank our lucky stars that we decided to have a doula present with us in the hospital room.

Yes, you're reading this correctly. As a dad, I strongly encourage parents to have a doula present at the birth, especially if it's in the hospital. I realize that for many dads this might be considered some sort of demotion of their role in the birthing process, but I see a doula's job rather differently. Let me explain.

First, when my wife, Deborah, and I initially interviewed doulas, we were looking for someone who could work with both of us and who would be respectful of my role in the delivery process. We ultimately hired a doula, named Sabine, who was very considerate of what our needs were as parents. While it was an additional cost to hire her, we thought it would be worth the extra money. Little did we know how true this would be as I'll soon explain.

When the day came for the baby to arrive, Sabine was there, not just to support Deborah, but myself in the process as well. The nurses seemed a bit taken aback by her presence but we were so glad she was there.

While Sabine was supportive of us, she took a backseat to our doctors and nurses; but then, after 19 hours of intense labor, it seemed that our baby was not going to arrive by natural means. The doctor then informed us that surgery would be necessary. At this, Sabine spoke up and asked for a few minutes to try some alternative birthing positions to help along the process. The doctor nervously granted the request and when Sabine instructed my wife to get off her back, the nurses were less than thrilled.

A few minutes later, our first son, Charlie, was born naturally. If not for Sabine, Deborah would easily have had a caesarian birth as were 32 percent of births in this country in 2007 - up 53 percent from 1996. In our home state of New Jersey, 38.3 percent of births in 2007 were caesarian. The reasons for these increased rates are often attributed to hospitals seeing caesarian births as a more controlled, efficient approach as well as having less insurance liability than a vaginal birth. The World Health Organization suggests that the rate should be no more than 15 percent. As a dad, I find the statistics about caesarian [sic] births in our country to be problematic and I feel very grateful that a doula like Sabine was present in both of our son's births.

So, if you're a dad-to-be and you are hesitant to rescind your position as the only advocate for the delivery of your child, consider the percentage of caesarian births in this country and how those statistics might change with an experienced doula by your side, giving you and your partner the support you deserve during one of the most challenging and meaningful days of your life.

(Dana H. Glazer is the award-winning director of the feature length documentary film, The Evolution of Dad. To learn more about the film, please visit