Saturday, June 23, 2012

Leah's Birth

I want to thank my client, Chelsea, for being willing to share her story for the benefit of other mothers. Her story is a long one, but it's well worth the read.
-- Mary

How do I even begin to tell this story that is so full of heartache, joy, love, pain and so many other emotions and feelings?

To really understand the meaning of all of this we need to back track a bit, to the birth of my son, Will. I saw an OB throughout my pregnancy with Will, had him at the hospital, including getting an epidural, having my waters broke and receiving pitocin. He was healthy; I was healthy and yet so many things happened on that day that I didn’t like. The nurse telling me to be quiet during pushing, the OB yelling at the nurse for more light while stitching me up and just the general feeling I got from the staff that I was “just another patient” to them.

I began wearing Will when he was 5 months old, which lead to cloth diapering at 11 months and my parenting philosophy began to evolve and change. I had become friends with several natural minded moms online through Babycenter’s Community website. One of those lovely ladies had had a homebirth with her daughter and had a slideshow of pictures from it on youtube. I watched it and was instantly moved to start researching this other world of birthing. We weren’t trying at the time and wouldn’t be for a while but I kept on with my research off and on for the next 2 years, until we had Leah. So when we found out we were expecting, we already knew what we wanted – a homebirth. I could go into great detail about why and all the statistics about homebirth but that’s not necessary here. Just know that having a homebirth was truly the desire of my heart.

We found out we were expecting May 13th with a home pregnancy test. We were instantly surprised but very, very happy and excited. We didn’t tell many people of our plans for a homebirth, mainly because I didn’t feel like defending my decision for the rest of my pregnancy. A friend of mine who had had a homebirth just months before we found out we were expecting recommended her midwife to us. I contacted her and we did an interview. We knew instantly that Mary was the midwife for us. I began seeing her for my prenatal appointments and LOVED the time I got to spend talking with Mary about everything pregnancy related. When I would go to see Mary, I didn’t have a wait and I spent an hour (sometimes more) with her. It was already so much better than my experience with my OB during my pregnancy with Will.

Everything was going well until one day at 15 weeks pregnant, I was having some minor cramping and lower backache at work. I called Mary and was given a list of products to pick up from the health food store and told to go home and rest. Mary was concerned that the pain was possibly being caused by uterine contractions. The rest and the products didn’t help – by that evening I was timing my contractions like early labor. They weren’t painful but they certainly were very concerning. We had ruled out a urinary tract infection, but things only seemed to be getting more serious. There was no point in going to the hospital because they wouldn’t do anything to stop early labor before 20 weeks. Finally, my midwife recommended that I drink a few ounces of wine to see if that would stop them. Sure enough, it did the trick. They stopped. I rested for the next few days after getting an ultrasound to make sure that nothing was wrong with the baby. Baby was perfect.

At 20 weeks, we had an anatomy scan done. We found out we were having a girl (yay!), but we also found out she had a little bit of excess fluid around her heart. It was recommended to come back at 26 weeks to check to see if the fluid was still there. At 26 weeks, the fluid was still there. My midwife set up an appointment for us to see a Maternal Fetal Medicine doctor. After having another ultrasound and having a video of her heart taken and sent off to a pediatric cardiologist, they saw nothing threatening with the fluid. The structure and function of her heart was perfect and there wasn’t fluid anywhere else. Thank God she was ok. Two scares already this pregnancy but we were so grateful to know that our little girl was ok.

The rest of my pregnancy went pretty smoothly. Leah’s position was constantly changing. So when she was sitting breech at 36 weeks, I wasn’t too worried yet. Mary massaged on my belly gently and was able to get Leah head down. Yay! However, at 39 weeks, my stubborn baby girl decided to flip…again! I went to the chiropractor, had the Webster technique done, put ice on my belly and even took a flashlight to my belly before bed and the next morning she was head down once again. Now it was a waiting game, just waiting to go into labor.

I started having irregular contractions during the day December 29th, almost 2 weeks before my “due date” of January 12th. I knew we were in the safe zone for having a homebirth, so I was okay with her coming then. The contractions continued after I got off work, so I went to Walmart after picking up Will from the sitter’s to pick up last minute food and supplies should this be the real deal. Jay and I got everything ready that night, including hanging the clear Christmas lights in the bedroom for the soft ambiance I wanted for our birth. It was calming and peaceful. I had texted Mary that my contractions were 3.5 minutes apart but weren’t painful yet. I took a nice long warm bath and went to bed knowing that if it was the real deal, I would be back up soon. About 1am I couldn’t sleep. The contractions were irregular and I was uncomfortable. I went to the living room, sat on the birth ball, and put on a movie. By the end of the movie, my contractions had fizzled out and I went back to bed. I took off Friday to rest, just in case we were in for a long night. After a few days of off and on contractions almost continuously, I had to get in the frame of mind that I wasn’t in active labor until I had to stop and breathe through the contractions. That night finally came almost two weeks after my labor initially started.

Around 10 pm on January 11th I noticed that my contractions were different than what I had been having for almost 2 weeks. I tried to lie down and get some sleep. Knowing how long my labor had been with Will (28 hours); I wanted to be rested in case I was in for a long labor again. Around midnight, I realized I was barely sleeping and was going to have to start working with my contractions soon. I had read some natural child birthing books about how to cope with labor and was putting those methods into full use. Back labor was in full swing already and I could tell this was going to be an intense labor. I kept telling myself that I would have the birthing pool later to labor in – I just had to make it until I could get into the pool. That was my motivation – that is what kept me going, knowing that some type of relief would be not too far down the road. I woke Jay up at 1:30am to come put counter pressure on my lower back – it helped tremendously!

I had been texting Mary during this time as she was finishing up at another birth an hour away. I continued to work with Jay through my contractions. Mary let me know that she was sending her assistant, Corina, to get the pool and she was on her way to my house. I was so relieved to know that my method of relief was on its way. I was so excited that our baby girl was on her way. We called my mom at 3 – she was here within 15 minutes, with Corina and Mary not far behind her. The back labor was already so intense that I had thrown up twice and was nauseous by the time Corina and Mary got to the house. Corina and my mom began setting up the pool and I was so looking forward to getting into it for some type of relief from all of the intense contractions. My water broke as they were setting up the pool.

And then Mary checked my cervix. She told me I was at 5.5cm. I was so excited to hear that! I had been a 2 at my last appointment so knowing I was in fact making progress was a real joy to hear. And then I could tell something was wrong. I could see it on Mary’s face. She asked Corina to come check me as well, for a second opinion. I had to get up to work through a contraction and then she confirmed what Mary had found – Leah wasn’t head down anymore. But she wasn’t butt down either. She was presenting knee first (at the time they actually couldn’t tell if it was an elbow or a knee). Leah’s heart rate was also going down on the Doppler during all of this, which they told me might be indicating a compressed cord. Mary was most concerned about her cord prolapsing because there was a lot of space near my cervix due to Leah’s odd positioning.

She immediately told me that she thought it was best that we transfer to the hospital. Right then I just went numb. Everything I had hoped for, dreamed for and yearned for with this birth was slipping through my fingers and there wasn’t a thing I could do about it. Because my water was already leaking, there wasn’t anything Mary or Corina could do to try to turn Leah around. My biggest fear of having to deliver at the hospital was quickly becoming a reality that was no longer in my control. The midwives called the hospital and told them we would be there soon with a footling breech and a decelerating heart rate and called 911, asking for an ambulance. While we waited, they kept me lying on my side, listening to Leah’s heart rate and Jay and my mom gathered our things for the hospital. I continued to work through the intense contractions during this time, which were now intensified because I had to stay laying down.

The paramedics were on their way and I remember thinking, I can’t believe this is happening. I didn’t cry. I didn’t act like I was upset. I was just…numb. I also wondered how in the world the paramedics were going to get a gurney into our bedroom. I started wondering how things were going to go at the hospital. I didn’t know if I would be able to continue to labor with this much pain in the position once we got to the hospital, if that would even be an option. I even remember talking briefly with Corina that if I had to get an epidural and deliver vaginally, that would be better than getting a c-section. It would all just depend on what they would say when we arrived at the hospital.

The paramedics arrived. It was 5am now. My mom stayed at the house with Will. I wanted her at the hospital with me but my son needed her more. I shimmied onto the gurney, they covered me with blankets because it was snowing outside - our first snow of the year - and they wheeled me out to the ambulance. Mary rode with me in the ambulance so she could monitor Leah’s heart rate and Jay rode with Corina, who followed the ambulance, even through the red lights. The contractions continued and now I didn’t have my rock of support with me. Mary tried her hardest to give me some relief with counter pressure on my lower back in between listening to Leah’s heart rate, but we were in a moving vehicle and she’s just not as strong as Jay. But I know she did her absolute best to help me. The paramedic kept trying to ask me questions. I was like, Really? You want to talk to me now? They got an I.V. started and took all my vitals on the way to the hospital. We arrived at the hospital and I remember thinking, wow, I’ve never entered the hospital this way before. I work for the hospital I delivered at, but never had I been through the ambulance entrance before. I’ve walked those halls that they wheeled me down several times, but I didn’t think they’d be wheeling me down the hallway because we couldn’t have the homebirth we wanted.

They got me up to the Labor and Delivery room and immediately they started asking both Mary and I a bunch of questions. Not a minute later, Jay walked through the door of my room and I was so glad he was there. They hooked me up to the monitors and did an ultrasound, confirming that Leah was sitting completely breech. I wondered what the different members were thinking. Did they think I was the crazy homebirth chick who couldn’t hack it? Did they think I was stupid for making the decision to have my baby at home? None of that really mattered but the thoughts were still running through my head. They told me I had no choice but to have a c-section. Once again, my choices were taken out of my hand and I was just along for the ride. I just looked at Jay and his face just told me everything would be ok. Mary told me she would be waiting for me when I got out of surgery, which was just amazing. I gave Jay a quick camera tutorial so that he could get those first few precious moments of our girl on film.

They wheeled me to the OR and I had to once again move to a different bed. The OR table was very flat, hard and not comfortable at all. And cold – man, was that room cold. They had me sit up at this point while I waited for anesthesia. I was praying that Leah was safe and ok as my contractions continued. I probably sat there for 10 minutes waiting for my spinal. As much as I hated the way things had turned out, I was very much looking forward to the spinal because I needed some relief from the pain. The nurse in the OR was really sweet and held my hand through my contractions as I breathed my way through them. I got my spinal. My toes got tingly and they started to prep my belly to bring my daughter into the world. I was still very concerned about Leah since they didn’t have a monitor on me. After they put the brown stuff all over my belly, they had to wait 3 minutes for it to dry. Those 3 minutes felt like forever.

I just wanted Leah here, safe and sound. I’m so glad Jay was in the OR with me that day. The surgery itself was a very strange sensation. I thought they would have her out pretty quick. I’ve watched so many baby shows and have seen how quick they can get a baby out. After feeling them tug and pull and tug and pull I was starting to get concerned. I know Jay was completely oblivious to the fact that it was taking longer to get Leah out than what it should have, which I was ok with. I didn’t need him to panic on me in the OR. And then I heard the OB say that Leah was stuck and she couldn’t get her out. I almost lost it right there, but I knew that hysterically crying on the OR table wouldn’t be a good idea so I fought back the tears and sheer panic. The thought of, Are we going to be one of those families that leaves the hospital with no baby? Am I going to be the woman who planned a homebirth only for it to go horribly wrong and end up with a c-section and no baby? ran through my head.

I quickly snapped back to reality when I heard the OB ask for another doctor to come assist her. I could hear the panic and concern in her voice which worried me even more. They finally got Leah out at 6:36am, but we missed that moment. I knew she was out when I looked over at the warming table and it was surrounded with staff as they worked on her. All I could think was, Cry, Leah, cry. After what seemed like an eternity, she finally cried. I had never been so, so happy to hear a baby cry before!

They said she weighed 6lbs 2oz, almost 1.5lbs lighter than Will. I was surprised she was so small. They wrapped her up and I finally got to see her. Our eyes met and I instantly fell in love. I gave her kisses and they took her away to get cleaned up. As they began to sew me up I started to get really nauseous. I needed to throw up but was too scared I was going to aspirate it. The anesthesiologist told me it was from the spinal, gave me some more fluids but it didn’t help. I finally did get sick in a bed pan, but it didn’t really make me feel any better. They finally finished sewing me up, put some warm blankets on me since I was freezing and took me to recover in the labor and delivery room we started in.

I was so ready to see our baby girl. We got back to the room. Mary was still there and then the OB came in to talk to us. She then told me I had a 7cm fibroid on the top of my uterus, which probably contributed to Leah not staying head down. And that she had to give me a t-incision in order to get Leah out. Out of everything that had gone horribly, horribly wrong that day, this was the cherry to top everything off. With a c-section, I knew that I could at least attempt a homebirth again someday if we decided to have any more kids. But a t-incision…that just took everything away from me. The risk of uterine rupture during labor would be really high. All of my choices, all of my options went flying out the window with those words. I tried not to focus on that.

I just wanted to see Leah. They brought her in not too much longer after that. They told me she was having issues regulating her temperature, but they brought her to me anyways so I could nurse her for the first time. I prayed that this first nursing session would go well. After a few latch attempts and some repositioning (nursing after a c-section is not easy since you can’t sit straight up), she latched on. It was amazing. They took her back to the nursery, needing to monitor her temperature and blood sugar. Sometime after the surgery, we found out that her 1 minute APGAR was a 1. I couldn’t believe it. That made me wonder how long she had been in distress before they were able to get her out of me, but I was just glad that they had gotten her out.

They got me moved to a room. Mary and Jay left to go home and get some sleep and I was left with my baby girl. I wanted Leah to room in with me so that we could get as much time together as possible. The first night, they did take her to the nursery since I was still so fresh from surgery and still had an i.v. and my catheter. They brought her to me for feedings though so I was happy about that. Nursing was going well, not perfect, but very well. There was lots of re-latching with most of the feedings, but I was determined to have a successful nursing relationship with Leah.

Friday night she got to stay in the room with me. She slept peacefully on my chest with the Boppy wrapped around us. She knew that was where she was supposed to be and I was so happy she was ok. I remember waking up Saturday morning to see the sunrise through my window. It was beautiful and it reminded me that even though we had just been through something very intense, there were beautiful days ahead. They drew blood from Leah Friday night which showed her to be jaundiced, enough for light therapy all day on Saturday. It was hard to be away from her for most of the day except for feedings, but I knew the more time she spent under the light, the quicker her billirubin would go back down to a normal level.

We were finally able to be discharged on Sunday. I was so happy to be going home. It was a tough recovery after my c-section. Not only the t-incision, but all of the tugging and pulling left my abdominal muscles very sore. When I got home I was ready to settle into a new normal. I’ll never forget putting Leah’s first cloth diaper on her thinking, We can do this. If we could get through the past 4 days, we can do it.

It’s 5 months later and I look back and know that there’s nothing that could have been done differently. That c-section saved my daughter’s life. My heart is still continuing to heal. I know it will continue to take time. I will never have the birth I wanted. I’ll never get to pull my child straight to my chest and latch them on right away. I’ll never get to delay cord clamping because that cord blood belongs to my child. I’ll never know what it’s like to crawl into my own bed right after birth with a new baby. But for everything I will never have, I have gained the world with the addition of Leah to our family. I have mourned the birth I lost and will never have and still have days where I mourn it. It is getting easier with time, but I think there will always be a part of me that will at least be sad for what I will never get to experience.

I am so very grateful to Mary and Corina, the two best midwives a girl could ask for. They may not have been able to bring my daughter into this world, but they provided me the support I needed in my time of need, not to mention the best prenatal care I could ever ask for. My mother was amazing and just stepped in the fill the role of taking care of Will while I was in the hospital. I will be forever grateful to her. And my husband -- I would not have been able to get through this experience without him. He was and continues to be my rock. I love him more and more each day. Breastfeeding is still going strong and has been a large part in the healing process for me. It was been incredibly bonding and I am very grateful that it has been without issues. I have a healthy baby girl and our family couldn’t be better.

- Chelsea Kaster

(Photos are not the author or her baby.)

Friday, March 5, 2010

Andrea's Birth....

I recently had the opportunity to attend a lovely home birth. It truly was beautiful and peaceful and wonderful in every way!

The birthing mother had a friend of mine, Rebecca Block, who specializes in maternity, baby and birth photography, there to capture every moment as a digital image. Rebecca put together the following slide show which is absolutely beautiful! I hope you enjoy watching the story unfold as much as I have!

Monday, October 26, 2009

The Ten Pound Baby - Too Big!

I've heard it a hundred times and I should be used to it. But I'm not.
It happened again last week.

My friend was having her third baby. She's already pushed out two babies without problems - an 8 pound and a 9 pound baby.

She's into natural birth, even considered a home birth... but then got nervous thinking about it and went on with the obstetrician. He is a nice man. I like him a lot. If I had to pick a doctor, he'd be in the top dozen that I know. But he works in the hospital and thinks the way he was trained.

Two months ago my friend came home from a prenatal with the shocking, horrifying news, "Mary, they did an ultrasound and my baby already weighs over five pounds! He's gonna be HUGE by my due date!"

I talked her through it: She'd already pushed out a 9 pound baby. This one probably wouldn't be that much bigger, if even that big. She has a great body for having babies. If she was worried about her baby getting big, she could stay away from refined carbs and sugars.
She looked skeptical. I wondered if she really was scared of doing labor again and was hoping for a c-section. I hoped not, but I had to think that perhaps that was going through her head... I loaned her some books and told her that she'd already done it twice, and I was sure she could do it again.

About two weeks ago, they did another ultrasound. This time she was told that her baby already weighed a whopping TEN pounds! Her doctor didn't like the idea of her birthing a 10+ pound baby, and she really didn't like the idea. They mutually agreed that she'd have an elective cesarean section on the following Monday. She'd be 37 weeks. Everything would be fine.

So last Monday, her belly was sliced open and this "giant baby" was extracted. He weighed 6 pounds, 7 ounces. She sighed and laid there waiting for everyone to put her insides back together while he cried and squirmed in the warmer.

The doctor smiled - another successful c-section! No respiratory problems for the baby, no issues with the mother. The ultrasound estimate of size was a little off... but no harm was done, so that really didn't matter, right?

The nurses smiled, too. All was well as the new daddy stood near his baby and held his hand and the mommy was stitched neatly closed.

This is birth... the American way.

Morning Sickness Remedies

Is there anything worse than to be excited about being pregnant, but to feel so nauseous that you can't enjoy it for months?!

I share these suggestions with my homebirth clients frequently, and thought that others might benefit from the knowledge as well. So here goes....

The cause of morning sickness is not really known, although there are many theories, including hormonal changes in pregnancy (elevated levels of estrogen and human chorionic gonadotropin [hCG]), low blood sugar (perhaps caused by not eating, thereby creating a vicious cycle), gastric overloading, slowed peristalsis (intestinal action), a body overloaded with toxins, and any number of other possibilities.
Nausea occurs in half to three-quarters of pregnant women. Most women experience the worst nausea and vomiting at about 11 weeks gestation. It typically begins around 5-6 weeks. About half of pregnant women with nausea and vomiting find it completely gone by 14 weeks and 90 percent by 22 weeks. Women with a multiple gestation (twins, triplets, etc.) often have longer-lasting and more severe nausea and vomiting. The theory is that the extra hCG produced during a multiple pregnancy may be the cause.

Persistent and severe nausea and vomiting beyond the first trimester may indicate hyper emesis gravid arum or hydatidiform mole and should be taken seriously.

There are so many different things that can help morning sickness, but there certainly isn't a "one size fits all" remedy! One or all or any combination or none may be effective for a particular individual. For many women, just knowing that something might help is comforting!

The following suggestions are well-known and fairly common remedies that often help alleviate or eliminate nausea and vomiting during pregnancy.

Please do not take these suggestions as medical advice! Always consult your care provider before trying something new!

1. Eat small, frequent meals, including a protein food each time, as often as every 2 hours, or just “graze” continuously, not allowing more than an hour or so to pass without putting something in your mouth. The food is more apt to be retained than 3 large meals a day and prevents the blood sugar from dropping enough to cause nausea. If this seems to work for you, keep snacks by your bed (almonds, cheese sticks, yogurt, peanut butter and apples, etc) and eat several times during the night when you wake to go to the bathroom. This will keep your blood sugar from falling by morning, leaving you feeling nauseous upon awaking.

2. Eat dry crackers or toast or plain yogurt before getting up in the morning.

3. Sip on ginger or raspberry leaf tea. The best ginger tea is made by pouring one cup boiling water over 3-5 slices of fresh ginger root. Let steep 5 minutes and sip slowly.

4. Take Ginger capsules with your meals.

5. Avoid foods with strong or offensive odors.

6. Many women claim that homeopathics are effective in easing morning sickness. The remedies are specific to symptoms. Research Pulsitilla, Sepia, Nux Vomica, and Ipecacuanha. Additional remedies to consider include: Antimonium Tartrate, Argentum Nitricum, Petroleum, Sulfur, and Tabacum. Good references are: “Homepathic Medicine for Women” by Trevor Smith, MD, and “Homeopathic Medicines for Pregnancy and Childbirth” by Richard Moskowitz, MD.

7. Drink carbonated beverages - especially ginger ale. (I wouldn't recommend doing this on a
regular basis, but it does help some women with severe nausea!)

8. Rest.

9. Vitamin B6 (pyridoxine) either 25 mg four times a day or 50mg twice daily can be very effective.

10. Use medication. Some women find 50mg Vitamin B6 and 1 Unisom tablet at bedtime in addition to 25mg B6 twice daily to be very helpful. (Or, 25mg B6 and ½ Unisom tablet three times a day). Unisom can cause drowsiness, and of course, consult your healthcare provider before trying any medication!

Feel free to comment, adding your own suggestions or what did or did not work for you.
I welcome the collective wisdom of pregnant women and their care providers everywhere!

The Best Care for Healthy Pregnant Women

As technical advances become more complex, care has come to be increasingly controlled by, if not carried out by, specialist obstetricians. The benefits of this trend can be seriously challenged. It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by obstetric specialists, even if the required personnel were available. Specialists caring for women with both normal and abnormal pregnancies, because of time constraints, have to make an impossible choice: to neglect the normal pregnancies in order to concentrate their care on those with pathology, or to spend most of their time supervising biologically normal processes, in which case they would rapidly loose their specialist expertise.

Midwives and general practitioners, on the other hand, are primarily oriented to the care of women with normal pregnancies, and are likely to have more detailed knowledge of the particular circumstances of individual women. The care that they can give to the majority of women whose pregnancies are not affected by any major illness or serious complication will often be more responsive their needs than that given by specialist obstetricians.

-A Guide to Effective Care in Pregnancy and Childbirth,
Enkin, Keirse, and Chambers, Oxford University Press

Tuesday, October 13, 2009

People Tell You...

People tell you how tired you'll be,
but they don't tell you...
that you'll be able to survive without much sleep
because the simple act of looking at your baby
is stirring, gratifying, energizing.

- Carol Weston

Tuesday, August 4, 2009

New Study: Home Birth as Safe as Hospital Birth

Is anyone in the medical community paying attention?
This wasn't exactly a "small" study.
Will ACOG revise their radical stand opposing homebirth?
I'm just wonderin'. . .

Look at these rates:
Intrapartum death:
Home: 0.03% vs. Hospital: 0.04%

Intrapartum and neonatal death within 24 hours of birth:
Home: 0.05% vs. Hospital: 0.05%

Intrapartum and neonatal death within 7 days:
Home: 0.06% vs. Hospital: 0.07%

Neonatal admission to an intensive care unit:
Home: 0.17% vs. Hospital: 0.20%

It looks like people were just ever so slightly more likely to be "safer" at home. Hmm....
And as a side benefit, more happy and comfortable in their own beds and bathrooms and living rooms. Oh, and it cost less.

No matter where you have your baby, there is no guarantee that it will all turn out well or that you will like the outcome or that whatever happened couldn't have possibly been prevented in the opposite setting. BUT, to say that home is more risky than the hospital for healthy women...
Show me!!

NEW YORK (Reuters Health) Jul 28 -
In terms of perinatal morbidity and mortality, a planned home birth is as safe as a planned hospital birth, provided that a well-trained midwife is available, a good transportation and referral system is in place, and the mother has a low risk of developing any complications, new research shows.

"Low-risk women should be encouraged to plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women's choice," Dr. A. de Jonge, from TNO Quality of Life, Leiden, the Netherlands, and co-researchers emphasize in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

Data regarding the safety of home births in low-risk women are lacking, due in part to the fact that studies with very large sample sizes are needed to assess relatively rare adverse outcomes. Moreover, randomized trials comparing home and hospital births have not been done because women usually want to choose their place of birth, the authors explain.

The present study, an analysis of 529,688 low-risk planned births, was conducted in the Netherlands, the only country in the west with a large enough data set. The group included 321,307 women who wanted to give birth at home, 163,261 who planned to give birth in the hospital, and 45,120 with an unknown intended place of birth.

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

"As far as we know, this is the largest study into the safety of home births," the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women.

BJOG 2009;116:1177-1184.

Friday, July 10, 2009

"Pit Her til Distress..."

Pit til distress... A scenario that happens all too often in the hospital.
The thought in the back of everyone's mind seems to be, "Well, we can always turn the Pitocin down, and if that doesn't work, we can always do an emergency c-section."

Here, the labor and delivery nurse tells it from behind the scenes:
Pit to Distress: A Disturbing Reality

Thursday, June 18, 2009

Natural Birth Blogs

Looking for more interesting natural birth blogs to follow?

Check out this list of 100 best natural birth blogs....
Top 100 Natural Birthing Blogs

Thursday, June 4, 2009

The Classic Old-School Doc Re-Appears

I am at one of the local hospitals pretty frequently, supporting doula clients in labor - often enough that I now have some favorite nurses and some of the L&D staff people remember me. That's usually a good thing.

I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.

As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).

Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.

As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.

Then labor happened.

The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.

Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"

And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.

"How are you, Ms. Smith?" he asked, touching her shoulder briefly.

"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"

"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."

"No, I - uh, don't want my water broken. Not right now, anyway."

"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.

Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"

"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."

Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."

I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"

He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."

He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason fItalicor this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.

Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.

Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"

"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"

Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"

Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.
"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."

Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."

The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"

Belinda meekly nodded her head and then looked away as she felt another contraction coming.

And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"

Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.

It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.

I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.

That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!

People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.

As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!

Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.

But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...