I experienced my first Pitocin induction this week. My client’s water broke four days before her due date, and she wasn’t having any contraction. So after much debate and a second opinion from a midwife, she agreed to being induced. I was expecting the worst, but the entire birthing experience went really well. The nurses started her off very slowly and her body kicked in so that she didn’t need a lot of Pitocin. The only negative effect of the induction was having the contractions so close together and active labor lasting longer. The mom gave birth after 19 hours of labor and never got an epidural or had any interventions. I was honored to be a part of their birthing experience and grateful for the experience of a necessary induction.
Thursday, December 17, 2009
Midwife’s Sign in Ancient China
"You are a midwife. You are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must, take the lead. Lead so that the mother is helped, yet still free and in charge. When the babe is born the mother will rightly say, 'We did it ourselves.'"
— Lao Tzu, in Tao Te Ching
Monday, December 14, 2009
Watch how a baby is born by cesarean section and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.
Thursday, December 10, 2009
“CARE is a leading humanitarian organization fighting global poverty. We place special focus on working alongside poor women because, equipped with the proper resources, women have the power to help whole families and entire communities escape poverty. Women are at the heart of CARE's community-based efforts to improve basic education, prevent the spread of HIV, increase access to clean water and sanitation, expand economic opportunity and protect natural resources. CARE also delivers emergency aid to survivors of war and natural disasters, and helps people rebuild their lives.”
I believe that we all want to help out our brothers & sisters to make this world we live in even better. We just have to use our hearts to pick a cause and start taking steps. Right now, I am helping women become empowered by their birth experience and giving children a more peaceful entrance into the world. This is just the beginning for me.
Wednesday, December 9, 2009
Here is a great birth story from one of my clients:
In bullet point form, because the challenge of composing coherent sentences is more than I feel like attempting at the moment:
• Started having contractions early in the morning on Saturday November 28th, sometime around 6am.
• Told Mark I was having contractions at around 9am, via text message from the bedroom, so I wouldn’t have to get jumped on in the process by Alexander. Contractions were light at this stage, and were coming every 10-15 mins or so.
• Sent Alexander and Rosie off to play with Auntie Katie and Uncle Marcus around noon.
• Then not a lot else happened for a while, so I had a bath and tried to get some rest because I was expecting a long day ahead of me.
• When Mark helped me out of bed after my rest, I felt a small gush of fluid between my legs. Not very dramatic. Did my waters break? Did I pee myself? Hmm.
• Decided to walk up to Katie’s house to get some fresh air and sunshine and move around. About 100m out from the house, felt another gush of fluid. This time I was certain that it was not a bladder control issue.
• Called my doula, who didn’t reply. (I actually still have not heard from my original supposed doula. I am rather worried something may have happened to her or her family over Thanksgiving?)
• Called my backup doula, Erica, who suggested Mark and I go out and continue on our little walk to see if that gets things moving.
• Walked around the block, running into several neighbours who seem…concerned that I was out and about. Visited with Katie while Alexander was napping. The outing did provoke a few more contractions, but still nothing serious.
• Went back to the house. Contractions continued all evening on and off, with varying intensity.
• Watched some television – a few episodes of “Coupling” – from the comfort of my couch.
• Every time I got up, there was a small gush of fluid, which I soaked up with an old towel between my legs. I know. Nice.
• My mood turned more serious around 7pm, and although contractions were still not that intense, they were coming regularly at 6 minutes apart, and I was getting concerned about the fluid leakage. We spoke to Erica, our doula, and after some deliberation, Mark and I decided to head in to the hospital.
• We got to the hospital and checked in around 8pm. I lay down on the bed and as soon as I did, contractions more or less stopped. Pah.
• The nurse checked me and pronounced me to be around 2.5cm dilated and 70% effaced, with my bag of membranes still intact. In other words, pretty much the same as at my previous doc appointment. PAH.
• Erica encouraged us to walk the halls to see if that would help move things along. We walked loops around the Labor and Delivery floor for the next hour. Erica had me walk through my contractions, which was challenging, but possible. Labour definitely picked up while I was actively walking.
• We stopped back at the room around 9.30pm to check in with our nurse. I lay down again on the bed, and once again, contractions dissipated when I stopped moving. I felt a little discouraged. It was late, I was getting tired and feeling hungry and it really looked like we were in for a looooong night. I was silently berating myself for coming in to the hospital too early.
• While we waited for the nurse to come by, Mark, Erica and I discussed possible options for what we would like to happen next. We agreed that if possible, we would like to be discharged from the hospital and head home for the night to recoup. Erica prepared me for the possibility that the doc may not want us to leave, since it seemed possible that I had a tear or leak somewhere that was producing the little gushes of fluid.
• The nurse came back, checked me again and announced no additional progress. We said we would like to head home for the night and our nurse agreed to check with the doctor. The nurse tested my pad for amniotic fluid and it came back negative (not sure how, but yay!), so we were dismissed with doctor’s permission for me to head home, take an Ambien (sleep aid) and try to rest up before a later attempt.
• We left the hospital, came home, had a quick bite to eat and I popped an Ambien and went to bed. The truly amazing thing is that I slept! I actually slept from around 11.30pm until around 6am! I woke up a few times through the night with contractions, but nothing dramatic.
• When I woke up at 6am, contractions had picked up. I stayed in bed for another hour or so, timing contractions which were coming around 6 minutes apart, but with stronger intensity than the previous day. After the previous evening’s events, I was determined not to go into hospital until I really knew I was making progress. So I slowly and methodically worked my way through brushing my teeth, washing my face and then I had a bath. Contractions really picked up in the bath, and I could tell that Mark was getting concerned about getting me back to the hospital. He tried to shepherd me through getting dressed, but I was determined to go slow.
• We got into the car at around 8.15am and called Erica and my doctor to let them know we were headed back to the hospital. Mark dropped me off at the entrance and went off to park the car. I huffed and puffed my way through a few contractions in the lobby area, attracting the attention of a passing nurse, who seemed very concerned and wanted to get me into a wheelchair. I declined, explaining to her in my firm, I’m-in-labour-matter-of-fact way that “No. I’m fine. I’m just having a baby.”
• Check-in was a lot more challenging this time. I didn’t want to hang around and chat. Mark could tell and he dealt with me and the check-in person.
• Erica met us at the check-in station and we headed to our room. I was kind of dreading being checked by the nurse again for progress. What if nothing had changed from the night before?
• Our nurse (different one from previous evening) checked me and pronounced me to be 7cm dilated and 80% effaced. YAY! Finally, some progress!
To be continued….
Continued from Part I….
• Once it was clear that baby was indeed on her way, it was time to go through the process of checking on the baby with the external fetal monitors. This process of being in active labour and needing to lie down on the bed whilst being monitored was something I had been dreading. I lay down on my side and the nurse attached the monitors. I stayed in that position for a little while, but not the full 20 minutes requested, opting instead to move to sitting on the ball with the monitors still attached. From my point of view, this was a good thing. I felt a lot less anxious about pain management once I got out of the bed.
• I’m not sure how long it took, but after a while, the nurse seemed satisfied with the data gathered about the baby’s heartrate and whatnot, and we took the external monitors off. Whew. Free at last.
• All this while, Erica and Mark worked with me to make me as comfortable as possible. Mark stayed close by and applied counter pressure to my back during contractions. Erica put cool wash cloths on my neck and placed peppermint aromatherapy oils nearby to help with nausea. Every so often I was aware that there was music playing softly in the background. I specifically remember listening to “Blackbird” at some point, and for whatever reason that song has stayed with me, floating around my brain.
• At some point, I went into the bathroom to use the toilet. While I was in there, the doctor who was on call came in to check on me. I thought I had met all the doctors at my OBGYN’s practice, but I didn’t know this doctor. So, I’m inside the toilet, with the door closed when the doctor, who I have never met, comes into the room. The very first words I hear come out of her mouth are something to the effect of “Has her water broken yet? No? Ok, well we can rupture the membranes to help move things along faster.”. Immediately, alarm bells started ringing in my head. This was not what I had in mind! I finished up in the bathroom and shuffled out to meet my doctor. I decided to introduce myself. “Hi. I’m Kristen. We haven’t met before.” I don’t remember exactly what was said from here, but between me, Mark and Erica, we made it clear that I was progressing just fine and no artificial rupturing of anything would be required at this point in time. To which the doctor replied “Oh. Well, I guess they’ll rupture at some point.”. She guesses? GUESSES? Pah. [Also, I'm pretty sure the doc was wearing some sort of perfume. If I had to guess, it was something Estee Lauder - either Beautiful or Pleasures. It may have been pretty faint, but I could still smell it. It made me feel nauseous. Ick.]
• I laboured for a while longer, mostly sitting on the ball, bent over the bed with my head on a pillow. I began feeling increasingly nauseous and DANG those contraction hurt. I started asking for an epidural. Mark and Erica talked calmly to me, explaining that in all likelihood I was going through transition and this was the worst part and soon it would be time to push and so on. And I wanted to believe them. But I was flat out terrified of having to lie on my back for delivery without any pain management in place. So I persisted with my request for an epidural.
• At some point around this time, a new nurse started working with us. Our previous nurse had been called in to assist with another birth in a neighbouring room. Although I liked the first nurse – she was supportive and upbeat – I was kind of glad when she left….because she was so supportive and upbeat. Apparently I prefer silence when I’m concentrating during labour. New nurse was a lot more quiet.
• An IV was placed to get the necessary fluids into me as required by the docs before the epidural could be administered. Then the anasthesiologist showed up and asked me to get into bed and lie on my side, so he could do his thing. I got onto the bed and lay down, only to promptly get up onto my hands and knees in preparation for an oncoming contraction. I figured I would deal with that contraction first before laying down, since I knew it would hurt more once I was on my side in bed. But the contraction just went on and on and on, and after a while, the anasthesiologist helpfully informed me that if I would just lie down, he could administer the epidural, and my pain would go away. I snapped my head up, and said “Yeah. I get that.” and finally succumbed to laying on my side.
• HOLY MOTHER OF ALL THINGS PAINFUL. Is there anything worse than having mega-contractions whilst laying down in a bed and trying to stay still so that someone can stick an enormously long needle into your spine? I THINK NOT.
• And then it was done, and the pain eased and I waited for the fog to lift. Which it did….sort of…except that my next set of contractions made me want to PUSH. My body knew what it wanted to do, and it just did it. The pushing motion broke my water and suddenly there was a full on gush of warmth. I told the nurse, Mark and Erica the news. “Uh. I want to push. And my water broke.” The nurse peered beneath the sheet that was draped over my lower body and asked “How long did you push with your first child?”. “Not long.”, I answered. The nurse promptly disappeared from my field of view and called in the doctor and delivery team. Meanwhile, Erica started to prepare the bed for push time, lifting the stirrups out for placement. As she was doing so, the nurse told her not to put the stirrups up yet and that we needed to wait until I was ready to push since the combination of the epidural and having my legs up in the stirrups for an extended period of time was a paralysis risk. As all this was going, the doctor arrived, checked me and asked the nurse to put the stirrups up, because I was ready to push. HA.
• All this while, I could still feel the contractions and I could still wiggle my own toes. The epidural had taken most of the pain away, but I still had sensation in my lower body. The first proper push attempt felt very different than it had with Alexander’s birth. I could feel what I was doing. And it was quite hurty. Meanwhile, the doctor started messing with my delivery zone, presumably to help prepare for the upcoming stretchathon. YOWCH. I snapped my head up and shouted at her “HEY! WHAT ARE YOU DOING DOWN THERE!”. She looked up and caught my eye momentarily before answering brusquely “Trying to make sure you don’t tear. It’s looking tight. Did you have an episiotomy with your first birth?”. “No, I did not!”, I replied. And in my head I was screaming “AND I DON’T WANT ONE THIS TIME, THANK YOU VERY MUCH.” but I kept that gem to myself.
• Fortunately, after about 20 or 25 minutes of working hard with the pushing, the baby appeared without any further drama, and the next thing I knew, she was there in all her glory, wailing and wriggling on my chest. For all the doctor’s doom and gloom, the baby was delivered with only very minor tearing and I did not need any stitches. So YAY for that.
• Oh, just remembered one more thing – when the baby arrived, the doctor announced “Congratulations! It’s a boy!” and I was all “What? A boy? Really?” while doc quickly corrected herself “It’s a girl! Sorry! A girl!”.
Suzanna Mary was born at 11.51am on Sunday November 29th, a mere ~3 hours after we arrived at the hospital that morning. Not a bad, eh? She is beautiful and perfect and nurses like an absolute champ. We could not be more thrilled.
Part III to follow soon – a short round up of what happened once Suzanna arrived and some general reflections on her birth.
A few notes from after the birth:
• Unlike when Alexander was born, with Suzanna, all the weighing and measuring and bathing etc were done in the delivery room, so she was never out of sight. This meant that Mark, Suzanna and I were never split up. That was nice.
• Since the epidural never really took hold of me, I was able to get up and walk to the bathroom by myself shortly after delivery. That was really nice.
• Did I mention that I didn’t need any stitches? That was really super nice.
• Katie and Marc came to visit us in the delivery room and helped us to move and settled into the new room.
• When everything that needed to be taken care of was completed in the delivery room, we were moved en masse across to the Nesting rooms. It was very close by. On our way to the new room, we passed by the same nurse I had talked to in the lobby area upon my arrival that day. The one who tried to get me into a wheelchair. I recognised her and said “Hey! I had my baby!”. She laughed and said “Well done! That didn’t take long!”.
• Once we were installed in the new room, it was still only early afternoon, so we had plenty of time for my parents, Alexander and Lennie to come and visit us. They brought us lunch from Uno. Mmm.
• We tackled a small mountain of paperwork that afternoon. Whew.
• Mark made sure Suzanna and I were settled in and happy, and then he was able to go out for dinner with Alexander and my parents, which was nice for Alexander. Mark came back to visit Suzanna and I at the hospital after dinner and brought us a few things from home, then he went home again to try to get some real sleep.
• Real sleep is hard to come by in a hospital. There are all sorts of people who need to come and poke at you at all hours of the day and night. And if they weren’t prodding at me, then they needed to check on Suzanna. So even though Suzanna was a perfect angel, and even though I was crazy tired, I still didn’t manage to get much sleep.
• Thus, when morning rolled around, my goal for the day was to get us dismissed from the hospital. There are a lot of items that need to be dealt with in order to gain approval to leave! We visited with Suzanna’s doctor, my doctor, Suzanna did a hearing test and had some blood work done, I had a tetanus shot and we filled in yet more paperwork. Alexander and Heather came to visit around lunch time, and then Billie came by to visit us after she finished work, and was able to help us to get packed up to leave.
• Finally, we got the all-clear to leave around 5pm. We secured Suzanna into her car seat and trundled down to the car with our belongings. Once we were all loaded into the car, Mark drove carefully up Mopac in the thick of Monday evening rush hour traffic, in the freezing cold rain.
My labour and Suzanna’s birth were so very different from Alexander’s arrival in so many ways. I don’t know why I was expecting them to be more similar, but it seems that whether consciously or unconsciously, I was expecting events to unfold in a similar manner and timeframe, and it kind of threw me for a loop when things didn’t play out the same way. In retrospect it seems absurd that I should have even considered that the birth of my very different children should be in any way the same.
One final note on the topic of Suzanna’s arrival that I don’t think I’ve mentioned up until now – she was born on her actual due date! For whatever reason, I had got it stuck in my brain that Suzanna was due on November 28th. But the doctors and nurses all confirmed that the official due date in my medical file was November 29th! So there you go. Suzanna was exactly on time.
Tuesday, December 8, 2009
It is Listening…
Not judging and telling your own story.
Support is not offering advice…
It is offering a handkerchief, a touch, a hug…caring.
We are here to help women discover what they are feeling…
Not to make the feelings go away.
We are here to help a woman identify her options…
Not to tell her which options to choose.
We are here to discuss steps with a woman…
Not to take the steps for her.
We are here to help a woman discover her own strength…
Not to rescue her and leave her still vulnerable.
We are here to help a woman discover that she can help herself…
Not to take that responsibility for her.
We are here to help a woman learn to choose…
Not to make unnecessary for her to make difficult decisions.
Monday, December 7, 2009
I attended a doula workshop on VBAC this weekend. This excerpt from Dutch professor of obstetrics G. Kloosterman really made sense to me:
Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine--nil nocere [Do no harm].
I personally believe that Western obstetrics could learn something from the Netherlands’ model of care since they have one of the highest percentages of home births and one of the lowest percentages of C-section rates and perinatal and maternal mortality in the world.