Misleading home birth headline

Yet another scary press release regarding home birth has come out today in advance of research which is set to be published in the upcoming issue of AJOG.  We’ve already seen in the Wax report how relying on birth certificate data can mar research, as the intended place of delivery is often not captured on a birth certificate.  Was the home birth planned with a skilled attendant present, or was it an extramural delivery (i.e. an unintentional home birth), which is more likely to lead to such scary “statistics”?  The press release also implies that “babies born at home are roughly 10 times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction when compared to babies born in hospitals”, never mind the fact that the soon to be published research looked at 5 minute Apgar scores, rather than the rate or cause of the stillbirths.  The authors of the study do concede that the stillbirths (associated with 5 minute Apgar scores of 0) could have been caused by factors OTHER than the place of delivery, such as undiagnosed stillbirths in the third trimester (intrauterine demise) or congenital anomalies, but that certainly won’t stop them from putting out a misleading press release nonetheless.  Wendy Gordon over on the MANA blog has already fired out an excellent response to this which is well worth reading, if you’re interested in understanding the truth behind the headline hyperbole.

Posted in Homebirth, Issues, Midwifery, Politics, Research | Leave a comment

Cesareans less likely when mother is a physician

There have been several studies which have looked into the economic incentives which might play into the decision making that leads to a cesarean birth, but a new report for the National Bureau of Economic Research (recently reported on NPR) has found that cesareans are 10% less likely when the patient in labor is a physician.  In other words, the more informed the patient is, the lower the chances of a cesarean.

In some ways, this is analogous to what happens when people take their cars to mechanics. People who are knowledgeable about cars are likely to push back against unnecessary repairs, whereas those who don’t know much about cars are less likely to take issue with the mechanic’s advice.

And interestingly enough, the converse is true when there are no financial incentives at play, i.e. when obstetricians receive a flat fee whether they perform surgery or not, in which case physician patients are more likely to receive cesareans…which kind of makes you wonder about the other patients who probably should be receiving cesareans, but aren’t.

Here’s the full abstract:

Physicians Treating Physicians: Information and Incentives in Childbirth
Erin M. Johnson and M. Marit Rehavi
NBER Working Paper No. 19242
July 2013
JEL No. I10
This paper provides new evidence on the interaction between patient information and financial incentives
in physician induced demand (PID). Using rich microdata on childbirth, we compare the treatment
of physicians when they are patients with that of comparable non-physicians. We exploit a unique
institutional feature of California to determine how inducement varies with obstetricians’ financial
incentives. Consistent with PID, physicians are almost 10 percent less likely to receive a C-section,
with only a quarter of this effect attributable to differential sorting of patients to hospitals or obstetricians.
Financial incentives have a large effect on C-section probabilities for non-physicians, but physician-
patients are relatively unaffected. Physicians also have better health outcomes, suggesting overuse of
C-sections adversely impacts patient health

Posted in Cesarean Birth, Hospitals, Research | Leave a comment

Healing after a Miscarriage

Hi, lovelies.  It’s certainly been awhile, and a lot has been going on.  I promise I will write some updates soon, but a great deal has been happening and I haven’t quite been able to process all of it yet.  Once the processing is finished, the posts will come.  In the meantime, I thought I’d share an amazing resource which has recently been brought to my attention with all of you.

Miscarriages are so incredibly common.  Statistically, 1 in 5-7 pregnancies will end in miscarriage, although many might occur before a woman even knows she’s pregnant.  I’ve personally had two.  And I’ve midwifed many women through a miscarriage.  In fact, I’m pretty sure if we all started talking about our miscarriages just a bit more, we’d be astounded by how common this is, and how many sisters all around us have been through it.  But that’s just it…no one talks about it.

And it is hard to talk about.  I’ll certainly give you that.  I can’t speak for anyone else’s experience, but for myself there has always been some element of lingering guilt attached to it: if only I’d taken better care of myself, or been less stressed out, or hadn’t gotten into that one fight, or hadn’t stayed up 24 hrs straight delivering a baby and gotten more sleep instead.  As if I had had any control over it in the first place.  It’s hard to accept that most miscarriages happen for no good reason at all.  Or actually, perhaps they happen for the very best reason possible.  If you stop to think about it, a miscarriage is the body’s way (or nature’s way, or God’s way, or the Goddesses way, or [insert spiritual belief of choice here]’s way) of ensuring that more often than not healthy babies are carried to term and delivered.  Think of all of the miraculous, amazing steps which have to go perfectly right in order to form a fetus.  If even one of those steps goes wrong in those early weeks, the implications for a living child can be devastating.  While a miscarriage can be absolutely harrowing, I do believe it’s kinder than the alternative.  And those early steps are pretty complex.  It’s not surprising that something goes awry from time to time.

But this is cold comfort.  And since it’s so rarely talked about, knowing what to do to recover and heal after a miscarriage is very rarely discussed. As a provider I’ve often searched for a resource or a guide to give to clients to help them ground themselves afterwards. And as a woman who’s been through it, I’ve found myself staring off into space afterwards, hands on a suddenly empty belly, wondering to myself: what happens next?  I think the answer to that question is so incredibly personal, for each and every woman.  But I did find this fantastic post over by Jessica from Smarter Each Day which is certainly worth sharing: Natural and Holistic Healing from a Miscarriage.  It’s worth a read, even if this has never happened to you, if only to allow you to better support a friend or sister who does have to endure this.  And for everyone else who has had to walk this path, what helped you heal afterwards?

If we all start talking about our own experiences just a bit more often, we’ll stop feeling so alone.

Posted in Midwifery, Miscarriage, Mothering | Leave a comment

Independent Midwifery in the UK threatened

It’s easy to get sucked into your practice bubble when you’re a midwife, and put your nose to the grindstone and not look up much.  Midwifery is like that; it’s one of the hardest jobs out there, demanding huge amounts of your energy and time, and it’s hard to take a moment to catch your breath, look around, and see what else is happening in the world.  However, the other day I had a moment to do just that, and I discovered that independent midwifery in the UK is currently being threatened in a pretty major way.

When those of us over here in the US think about midwifery in the UK, I suspect it’s often done with an envious sigh.  Midwifery in the UK certainly sounds a lot better than the deal we’ve got in the US right now. For one thing, there is an integrated healthcare system in the UK, which means that midwives have a seat at the table; they are considered a vital and respected part of the healthcare system, rather than viewed as minority at best, or at worst a fringe element practicing outside the medical system (and there are still plenty of states where some forms of midwifery care, such as home birth, or certain credentials, such as CPM, are  still illegal and unrecognized).  Of course, it doesn’t help that midwifery in the US is fractured at the moment, with no standard definition, educational path or credential (I’ve talked about this a great deal in previous posts, but if you’re still confused about CNMs v. CPMs v. CMs v. the ACNM v. MANA etc. etc., start with this post here and move on from that).  The truth is, they have a much longer and crucially unbroken midwifery heritage in the UK than we have here in the US; the unbroken aspect of it being key, I think.  In fact, Mary Breckinridge, an early pioneer of midwifery in the US and founder of one of the first midwifery educational program here (the Frontier Nursing School), was actually trained in England and brought British-style midwifery to our obstetrician-dominated shores.  The history of midwifery in the US owes a lot to England.

Right now, as it stands, midwives practice in the UK in one of two ways (and UK readers, please please PLEASE correct me if I’m wrong about this): either as part of the NHS, or as an independent midwife (IM).  IMs are fully licensed and qualified midwives who choose to practice outside the NHS, most often in private practice or self-employed, either delivering in a private hospital or more frequently attending home births.  They’re able to offer the gold standard of midwifery care: one-on-one continuity of care, meaning that they provide all of the woman’s prenatal care and are also the one at her delivery.  Because they work outside the NHS, they charge their own fees and are reimbursed directly by the client, rather than the NHS.  Even so, they are still part of the larger healthcare system.  In the event that a home birth requires a transfer, an IM is able to smoothly transfer her to a hospital without the usual bruhaha so common here in the U.S., and either continue the care for her client in the hospital as her midwife, or remain with her as her advocate, often going into the OR with her if a cesarean is needed.  As it stands right now, most IMs don’t carry malpractice insurance.  This is because the number of IMs in the UK is so small that it’s been impossible for them to contract affordable premiums based on the small size of the IM pool.  If there is a lawsuit, any damages paid out aren’t covered by an insurance company, and often come directly from the midwife’s assets (not exactly ideal), which means that most pay-outs are incredibly small.

However, a new EU ruling is about to go into affect in October, 2013, which will require that all independent midwives now carry malpractice insurance–or in other words, make it illegal to practice as a midwife WITHOUT malpractice insurance. And given that the pool of IMs sharing the costs of insurance is so small, the insurance premiums would be exorbitantly expensive–prohibitively so.   Which means that if they can’t afford malpractice insurance, they’ll be practicing illegally.

Now you might ask, what’s the big deal?  Well, the point is that carrying insurance doesn’t improve birth outcomes, it just increases the rate of lawsuits.  As Milli Hill writes so succinctly in her article in the Telegraph  (Home Delivery: Why Independent midwives are key to the fight for birth freedom):

IMs argue that insurance is a profit-making industry, and that it is good standards of practice that make midwifery safe, not insurance policies. They also point out that by making insurance a compulsory prerequisite of registration, there are implications for the freedom of all midwives, not just independent ones. Potentially, the legislation could further erode birth freedom for women too, with insurance companies gaining a say in where and how they might be happy for births to take place.

If they fail, and Independent Midwifery becomes illegal, this will be a grave blow to birth freedom in the UK. The NHS will be left unchallenged, a monopoly, and a system that already seems to be over-stretched and flawed will be left to continue without an alternative for anyone to compare it to. Women who seek an different option to the mainstream will have no choice but to birth unattended, or perhaps in secret with an midwife practicing illegally. Will this really improve birth safety?

If you’re a citizen in the UK, this is a vitally important issue.  Please visit Choose Your Midwife, Choose Your Birth to sign the petition (only UK citizens are able to do so) and to find out more about upcoming rallies and activities (you can even write a letter to MP Dan Poulter, who is currently refusing to meet with IM in the UK).

Posted in Homebirth, Hospitals, Issues, Midwifery, News, Politics | Leave a comment

What to Reject When You’re Expecting

Check this out: A fantastic new guide written by Consumer Reports (who would have guessed?) about what to reject when you’re expecting, including unnecessary cesareans, elective inductions, routine amniotomy and episiotomy, and babies routinely going to the nursery.  Coupled with advice on what to look for instead, including midwifery care!  Well researched and very refreshing.  Be sure to send this to all of your pregnant friends!

Posted in Birth Education, Cesarean Birth, Epidurals, Episiotomies, Inductions, Labor and Birth, Midwifery, VBAC | 1 Comment

A wild ride so far

One month into my new job as a home birth midwife, and I must admit, I am wholly, unashamedly, unequivocally LOVING it!  I’ve attended 4 births so far, 3 of which were in the home and one of which was a transfer (and I’ll have to write more about that later, but let’s just say that it was a HUGE learning experience. Not an emergency transfer, thankfully, and everything turned out well, but no one wants to transfer, even if it’s the right thing to do.)  However, it’s been a bit of a fly-by-the-seat-of-your-pants month.  Doing shift-work at a hospital all my career has made my life generally a lot more livable–being able to know when the end of your shift will be, and to pass on your women in labor to the oncoming (fresh and perky) midwives and go home and get some rest is a really nice lifestyle, truly.  As a home birth midwife, we’re there not necessarily from the very start of a labor (we try to arrive once active labor has started, which is sometimes hard to judge), but we stay until the very end, and women can easily have 2-3 day births.  My second week of work we were with one woman for 34 hours. Just a few short days later we were with another woman for 26 hours.  These are really long work days, to put it mildly.  Thankfully since my midwife partner and I are going to all the births together for the time being while I orientate to home birth, we’re able to spell each other and take some naps on the couch during these marathon births, but even so…it’s a whole new level of work-induced sleep deprivation (although not nearly as bad as being a new mother, since these periods of extreme sleep deprivation are not *every* night, just every now and then). However, when I come home from a 34-hour birth, I’m not always able to fall into bed and pass out for a day. I’m a mother, after all, and the bambino has no concept of being up all night, and even if he did, he wouldn’t care.  But I’ve been lucky so far to be able to rest a little bit after these long deliveries, and I’m hoping that my back-up childcare options continue to work out so fortuitously (as well as the back-ups of the back-ups). And there are still women who need to be seen for their prenatal visits in the office the very next day, no matter how much you’d like to cancel the entire day and just sleep.

Last night we were called around 3:00 am to attend a first-time mother in labor.  Having just come off a string of such long marathon births, I was wholly prepared to show up and stay with her for another 14 hours or so (at least), but her labor was taking a different turn. The baby arrived promptly after only approximately 3 hours of active labor, and a 20 minute or so push.  In fact, when she started pushing and said she could feel the baby starting to come out, I was a bit skeptical, since I was thinking first-time-mom = 1+ hour push at least.  But I put my hand in the water (she was pushing in the tub) and lo and behold, she was crowning! (For what it’s worth, my much more experienced midwifery partner was not fooled; when the mom said she could feel the baby coming out, she wisely got a pair of gloves, rather than just smiling and nodding.)  It was my very first time delivering a waterbirth, and it was pretty spectacular.  Thankfully it was happening so quickly I didn’t have much time to get nervous about it, and the woman could have easily delivered this baby on her own without any assistance at all.  The head came out quickly, the shoulders followed immediately (with a surprise nuchal hand), and I lifted the baby up out of the water and placed her on her mother’s chest and voila! We all gazed in wonder at the newest human to join us Earthside while the baby loudly told us exactly how she felt about her new change of scenery.  It was beautiful.

And in fact, it’s just so fabulous to get to develop a relationship with your clients, and be able to promise them unequivocally that *yes* you will *will* be at their birth, a luxury I never had with my last job since it was shift work and I could never guarantee to my patients that I would be the midwife working on the night they happened to go into labor.  The pace of the office still remains a mystery to me, though. While I’m only booked for 5-6 clients a day, which on paper looks as if it would be a cake walk compared to the 26 patients I was expected to see in a single day at my old job, the visits are so much longer, more in-depth and more intense.  And I am once again discovering that I’m very slow, and I’m getting backed-up and making people wait again, which is much less acceptable in private practice than it is in a big public hospital where women are expecting to have to wait for their visit.  I still have so much more to learn, but it has been an exhilarating month so far!


Posted in Birth Stories, Homebirth, Labor and Birth, Midwifery, Vaginal Birth | 2 Comments

Taking the plunge

Well, the time has come. After nearly 5 years working with the vulnerable and inspiring women at an urban public hospital in New York City, it’s time to move on and follow my dream.  I have always, always known I wanted to be a home birth midwife, even when I was just a student, and now, after catching nearly 400 babies, taking care of hundreds of women (including triaging and managing some very high risk situations with collaboration), and going through my share of emergencies, I finally feel like I have enough experience and am  ready to take the plunge.  And what a plunge it’s going to be!  In many ways, I think I’m going to have to un-learn nearly as I’m going to have to learn for the first time: when to make the call on a transfer, how to resuscitate a newborn in a living room, how to let labor unfold without interference or vaginal exams (yeah, that one sounds pretty easy–and a pleasure to not have the hospital’s ticking clock hovering over my head–but even so, I’ve gotten very used to doing exams every few hours, and I’m going to have to rely on other signs now to assess labor progress), how to triage over the phone, how to be on-call 24/7, how to deliver women in any position of their choosing, etc. etc.  What a change it’s going to be!  I will say, though, that I feel like I have found the *perfect* situation for myself to learn all of this in.  I’m joining the private practice of a home birth midwife who’s already well-established, has been practicing home birth for several years already, and is really open to mentoring me and taking me under her wing while I’m learning, besides the fact that she’s incredibly intelligent, fun, enthusiastic and practices in a way very similar to me (for example, I think we’re both on the more conservative end of home birth, will definitely be following ACOG intermittent monitoring protocols to a T, and will probably be transferring sooner than other home birth midwives might–which isn’t to say that other home birth midwives are taking unnecessary risks, only that I think we’re both pretty similar in what we’re comfortable with in a home setting, which is a really good thing).  Part of me is wondering what I’ve gotten myself into, and is definitely nervous–no less for the life-style adjustment than for all of the new skills I’m going to have to learn. And I keep reminding myself that doing anything new is always hard, and always requires a big adjustment.  But part of me is so. damn. excited–it’s not even funny!  Hour-long prenatal visits, gyn and family planning–I’m even going to learn how to do IUIs (intrauterine insemination) and infertility consults–this is a chance to deliver the kind of care I have wanted to give to women since I was a student, but haven’t been able to since I was curtailed by the limitations of the public hospital system (15 min prenatal visits tops, for instance).  Anyway, I’m sure I will have much to update all of you with in the weeks to come. My new job starts next week!

Posted in Homebirth | 1 Comment

10th Anniversary Miles for Midwives: Come on down!

I write about this every year, but this year I’m one of the organizers for this event, so it’s even more near and dear to my heart.  We’re having the 10th Annual Miles for Midwives this coming weekend, October 6th, in Prospect Park.  Miles for Midwives is a 5K run/ walk race which jointly benefits the NYC ACNM chapter and Choices in Childbirth, both fantastic organizations which do a lot for promoting natural childbirth, making informed birth choices, education, and the advancement of midwifery as a profession.  It’s a great cause, and it’s *always* a fun morning.  First there’s the run/ walk, then a pee-wee race for the toddlers, plus a Birth/ Wellness fair full of goodies like yoga and massage, tons of information on birth/ mothering/ parenting resources in New York City, and even face painting for the little ones. It’s not too late to sign-up to race.  Register now! (And keep your fingers crossed for a nice sunny day).

Posted in Midwifery | Leave a comment

Home Birth Debate Heats Up

I’ve been meaning to write about this for awhile now.  The debate about home birth, usually relegated to the side-lines in the larger debate about birth, has hit the big time recently (well, back in June) as some of our nation’s top female journalists waded into it full force.  First, Michelle Goldberg at the Daily Beast wrote the following post: Home Birth: Increasingly Popular, But Dangerous.  This was answered by Jennifer Block on Slate (who’s also author of the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care) in her article How To Scare Women. Michelle Goldberg then went on to write a response to Jennifer Block’s critiques.  But the two articles that really got me excited were the following commentaries on the back-and-forth between Goldberg and Block: Smart Women Debate Home Birth by Ceridwen Morris, and Can We Have a Civil Debate Over Home Births? by KJ Della’Antonia at the NY Times, because these were both less polarized takes on the debate which advocate the middle option, which is what I agree with.

There’s something wrong with a system that has so colossally failed women that for some, in response to this, the only answer is to go to the extreme of having an unassisted home birth, where no medically trained person is in attendance.  While I can certainly sympathize with the views of women who choose unassisted childbirth, for myself, I’ve worked in obstetrics long enough to know that sometimes, even when everything is going right, there are still plenty of terrifying emergencies which can happen in the blink of an eye, and which need a very swift response by a medically trained person (not that these emergencies happen often, but they DO happen).  But then, I am a midwife, and this is my job, so naturally I would advocate for a midwife to be in attendance at  every home birth.  That said, given how variable the training system and educational pathways are for midwives in this country, there is no single standard for midwifery education, which means that even if you do elect to have a midwife at your home birth, there can still be a huge difference between the skills and knowledge of your attendant, and many of the tragic mistakes you hear about on website’s like Dr. Amy Tuteur’s Hurt By Home Birth site reflect these discrepancies.   But I think the biggest problem we face with home birth lies in the fact that there is no integration in our health care system between home and hospital, and this is what I would advocate for more than anything else (the middle way, I would argue…and I’m certainly not alone in pushing for this!). When you look at other countries with the highest number of successful home births, like the Netherlands and England, each of those countries has a systematic approach to home birth. Women who choose home birth are not seen as wackos who’re going outside the healthcare system–they’re still very much a part of the system, and they receive care similar to their hospital-birthing contemporaries.  And when something happens which deviates from the low-risk standards which have been established for home birth, they’re transferred to the hospital without any judgements or accusations, simply an escalation to the next level of care that’s needed, end of story, and lo and behold, they have MUCH better outcomes than we do.

I’m currently in England for the summer, and I went out for lunch a few weeks ago with a British midwifery student, and we got to talking about babies and birth (go figure).  At one of the hospitals she’s training at (King’s College Hospital), which has a very successful home birth rate, pregnant couples are presented the option of home birth right alongside their other options at the start of their prenatal care (just look at the link above, it says it right there in the hospital info page: “You can choose to give birth in the Nightingale Birth Centre at King’s or, if you live in the King’s catchment area, at home with the help of our community-based midwives.”), and if they choose to have a home birth, they receive prenatal care from a collection of community midwives who work for the hospital, and who will attend their birth. If everything goes to plan, they deliver at home. But if there are any deviations from normal (and I’m sure they have a very clear policy on what’s normal and what’s not), they’re transferred to the hospital, and they give birth at Kings with the technology they need, and with attendants who don’t view the transfer as a train wreck, but as an appropriate response to their individual situation.  Which means that rather than receiving unnecessary intervention, they’re receiving the exact appropriate level of intervention they need on a case-by-case basis.  What a breath of fresh air compared to the U.S. system, where finding a back-up physician is next to impossible for many hone birth midwives, which means when they have to transfer a client to the hospital, they have no rights or recognition as a midwife at the hospital they transfer to, and they’re not transferring to a specific attendant whom they work with and who supports their client, but instead are at the mercy of whomever happens to be working that day (usually an OB resident), who will know nothing about the client before she comes in, and will probably view the transfer as another “home birth train wreck” which needs cleaning up.  Not exactly ideal, right?  But then, we live in a country where the idea that healthcare is a fundamental, universal right which every human being deserves is still being hotly contested.

In any case, it’s nice to see home birth in the national news. We can only hope that with the debate taken to a whole new level like this, awareness will spread, and perhaps increased awareness will lead to increased demand, which will lead to changes in our system which is currently failing so many women, and perhaps even lead to a more integrated system down the road.  One can certainly hope, at any rate. (Or move to England).

Posted in Choice, Complications, Homebirth, Hospitals, Issues, Labor and Birth, Midwifery | 4 Comments

Josiah Morgan’s Birth

Another beautiful birth story to share with all of you, this time a successful VBAC in a hospital with an intense pushing phase (but all turned out well, as you shall see!). Enjoy! (And thank you, RH, for sharing your story!)

Josiah’s birth story begins the weekend before he was born. I had been through a rough appointment with my OB’s partner (and the CNM at that, not the other OB). She wouldn’t let me leave the office without my c-section scheduled for 42 weeks, which was the following Thursday. I was overdue, swollen, tired and just ready to meet my baby boy. I posted to a few groups about my frustration and it was suggested to me that I look into acupuncture. So, on Friday afternoon I went in to see a local chiropractor who did acupuncture. We did a session, and I went home. We took the kids to the community pool after LJ got home and enjoyed some family time.

Saturday morning, we woke up, got everyone dressed and went down to the beach with my parents. We had quite a fun day together. The kids loved the sand and water. We were on the family beach, which was a lot quieter than the “real” beach. We didn’t have to worry about the tide (which was nearly fully in when we got there), waves, anything. Sunday we went to church as usual, stopped for sushi on the way home. We decided to take advantage of our last chance to enjoy the pool before the baby got here, because one way or another he’d be here this week. At the end of the day, we were quite content with our fun-filled final weekend as a family of four! (Try saying that four times fast!)

Monday we didn’t do much. LJ went to work, I went to get more acupuncture done. I had some minor contractions, nothing that was enough to time and they were barely noticeable. I was supposed to go for more acupuncture on Tuesday, but had decided to spend the day at home working on cleaning the house, getting laundry caught up, everything I wasn’t going to be able to do the rest of the week come Thursday.

Tuesday morning started like every other day. I fought to get out of the bed and got LJ ready to go out to work. When he left, I used my breast pump for a few minutes, trying one final time for the day to get labor started. Nothing. Not even a tightening. Jonas woke up and was hungry, so I put the pump up and started to get up to get him breakfast. And that’s when it happened. Right at 8:00AM. The telltale “pop” quickly followed by the gush… and gush… and gush. My water had broken! I called LJ and told him he needed to come back home. He had just pulled in his parking space at work! I called my mom to come get the kids, and called my doula, Carrie, to let her know today was the day. I called out for my sister (who had been staying with us to help me) to bring me a towel. I couldn’t move without gushing more fluid. We got the kids ready to go to my mom’s house, and I started making the cappuccino muffins I’d planned on bringing the nurses. By now my water had been broken for an hour and I started getting contractions. They started out slow, about every 10 minutes. I finished the muffins, then my mom arrived and took the kids. We kissed them goodbye, and our house was quiet. We didn’t want to jump the gun with going to the hospital, so we hung out at home for a couple hours. The contractions started to grow closer together, about 4-5 minutes apart. We decided around lunchtime to head on to the hospital. We waited for me to get something to eat (because I knew they wouldn’t want me to eat at the hospital), then we stopped by Taco Bell for LJ (there’s a first—contractions in the Taco Bell drive thru!) and headed on to St. Luke’s.

On the way to the hospital, I listened to the “Easy First Stage” Hypnobabies track. It certainly helped make the trip down 95 a lot easier. We got to St. Luke’s, checked in and were sent to triage. I handed over the cappuccino muffins to some very happy looking nurses. Since I told them I was using my third towel to catch amniotic fluid, they didn’t bother checking to see if my water had truly been broken. Carrie arrived and we were soon transferred to a birth suite. I had several people come in and do some things. One nurse came in and asked about a million questions and had me sign a bunch of papers. One nurse came in and put me on the monitor. Another nurse came in and tried to start an IV. Fail. We asked to wait a bit, and stating something about being back because we needed it “in case of an emergency” she left. The anesthesiology nurse came in and asked a ton of questions and wanted me to sign the consent for anesthesia “in case of an emergency”. I got tired of hearing that phrase. When I asked to wait, he reluctantly accepted. He then offered to get my IV started. His first try was too close to a nerve and right as a contraction started, and I made him stop. His second try was an immediate success. We were left alone then for a while. LJ rubbed my feet with some oils Carrie had. It felt good. The contractions were slowly but surely getting more intense and closer. The room we were in was really hot. We asked for the temperature to be turned down, but apparently it was not working properly, so we were transferred to another birth suite. I walked to our new room, pausing for contractions. We got settled into the new room.

With each contraction, I had an overwhelming nausea. LJ and Carrie each held a pressure point on my ears and it helped get me through. At one point, the nausea got to be too much and I asked for some Phenergan. It made me drowsy, but I was still able to focus during contractions on my relaxation, with LJ and Carrie’s help. With every contraction, one or both of them were there to use a relaxation cue and help me get into hypnosis. At this point, I had been checked and I was only at 1-2cm.

The nurses had given me one or two bags of IV fluids, and at one point they wanted me to go to the bathroom. I got up and walked to the bathroom. I tried to sit on the toilet, but the intense pressure was way too much for me to handle. I just couldn’t sit down. I tried to go standing up, but that was a no-go as well. I told LJ I wanted something for the pain. I think he maybe thought I meant an epidural or spinal, because he tried severely to talk me out of it. He reminded me how important a natural birth was to me, and how I desperately wanted my VBA2C and pain medicine would possibly hinder that. I said I just wanted something in my IV. The nurse came in and said they needed me to use the bathroom. I said I couldn’t do it, and asked to be catheterized. They cathed me and Dr. VanScriver came in to check my dilation. She said I was 2-3cm. 2-3?! For real?? At this point I should at least be a 6! Why wasn’t I dilating quickly? I was relaxed during contractions… well, sort of… I later found out that she was being “generous” and I wasn’t really 2-3, more like still 1-2. I asked for something mild to take the edge off and help me focus again. She gave me Stadol in my IV. And that’s where everything goes fuzzy.

I remember contractions. I remember being encouraged to “release”. I also remember Carrie leaving for a little bit. I remember seeing LJ and Carrie drinking Cokes and wanting one for myself. But, I also remember things that weren’t there. Like my oldest son giving me dirty looks, sitting in my living room. My mom and I talking in her kitchen. Other things that just weren’t happening, and I remember responding to them, and then being brought back to reality when LJ would ask me why I was asking him why he was looking at me like that, when he was across the room talking on his phone. That’s about all I remember of my experience with Stadol. Carrie later informed me that they were able to let me listen to several Hypnobabies tracks and I was a lot more focused afterward. She got to go pump for her baby, they ate dinner and got to get ready for what was coming.

Shortly before midnight I believe (given the timetable I have been told), Dr. VanScriver came in and checked me. I was 9cm. NINE!! For a brief minute, I got nervous. Here I was, where I got to with Arianna. My body had never gotten past 9cm. Could it get there? BAD THINKING!! I could do this. Easy. This was what my body was made to do. I started feeling “pushy” and Carrie picked up on it immediately, based on the noises I was making (sign of a good doula!). I think she or the nurse suggested I get checked again. Sure enough, I was at 10cm with a little bit of a lip! I couldn’t believe it! I didn’t have a faulty cervix! I got to 10cm! Now came the hard part…

The room had quickly transformed from the pretty suite into a “procedure room” look. All the birth tools the doctor would need (and wouldn’t need but were there “in case of an emergency”) were ready and waiting. I was given the go-ahead to start pushing, although I think my body had been doing some of that on its own. I tried to find a good position to push. I pushed on my hands and knees, but they lost the baby on the monitor and wanted me to move positions so they could read him. I tried to push lying on my side. I couldn’t even get on my side. The pressure I felt was way too much. So, I laid on my back in a semi-reclined position and pushed. They still had trouble getting Josiah’s heartbeat on the monitor. We got it settled, and I started to push. I pushed for a couple hours and kept accidentally moving the monitor, so the doctor asked to put in a IFM (screw in the head to monitor his heartrate). I didn’t want it, but if it kept the nurses from having to find his heart rate as I pushed, I would allow it. I was tired of the external monitor. I pushed some more. It was intense. I finally found a position that was moving him down and a routine that worked for me. I’d wait until I felt the urge to push. LJ and Carrie would grab my lower legs, I’d grab my thighs and push as long as I could. Then LJ and Carrie would each grab my ears to keep me from throwing up. I’d push again, then rest and Carrie gave me a sip of water and I’d put the oxygen mask on they gave me. The oxygen helped a lot.

I heard someone say, “He’s crowning!” I felt his head and couldn’t believe I was so close to holding my baby! We pushed a few more times and the doctor tried to stretch my perineum out so he could get out. Nothing she or I could do would stretch it enough. He was stuck on my perineum for an hour. She numbed it and we tried pushing some more. I began to tear below my perineum, so the doctor said I would need to get an episiotomy. I begged to let me go one more contraction before cutting, and she let me. I couldn’t push him out though. So, she cut me. That sound is nauseating! And what does my wonderful husband do? Comment on how nauseating the sound is! I thought Carrie and I were going to beat him up! He quickly stopped commenting.

Shortly after the episiotomy, I felt him move down even more. I think it was two or three more good pushes after that I felt intense stretching and pressure and then relief. He was out. He was here. He wasn’t really crying. I was scared to death. They suctioned him in between my legs, then put him on top of my chest as they cleaned him up and tried to get him to cry. He was moving, just not exactly pink and not wanting to cry. They let LJ cut the cord and took him over to the warmer. Those few minutes of silence were deafening. I was scared to death. I wanted someone to tell me what was going on. LJ would look over there. One of the nurses told him what was going on. Josiah would breathe and cry when they rubbed him, but when they stopped, he didn’t want to cry. They called the neonatologist in. Josiah had a fever of 102. They wanted to take him to the Special Care Nursery to make sure he wasn’t sick, didn’t have meconium, etc. I said ok, but I wanted to see him first. The neonatologist acted like I was crazy. Of COURSE I’d get to see him first! They brought him over to me. I kissed him. My littlest man. He was so wonderful, so beautiful. He looked just like his brother. I kissed him again and let them take him, escorted by his daddy. I laid there as the doctor stitched me up. I delivered the placenta about 25 minutes after Josiah. As soon as she was done, I sat up. I felt great! Well, yeah, I was sore. Really sore. I felt like a Mack truck had been run through me! But, compared to the c-sections? TOTALLY different! After a while, I got up and walked to the bathroom. Compared to being catheterized for 24 hours following a c-section, totally great! Carrie helped me back to bed, and got me my cell phone so I could be in contact with LJ.

Different than the calm before the storm, the calm after was quite unique. All of the medical equipment was removed from the room. The nurses left, the doctor left, it was just Carrie and I. We sat on my bed mostly in silence. I was digesting everything that had happened over the last 19 hours. Every now and then I would say, “I can’t believe I did it.” She filled in a few details, like my true dilation the second time I was checked, what I did during my Stadol time, etc. I apologized to her for any bruises she may have on her arms. I was holding on pretty tight to her and LJ at one point. She said it was normal. She offered to help me shower, but I refused. I wanted to keep by my phone to make sure Josiah was ok.

About an hour after birth, I was getting anxious. I wanted my baby. I had lost an hour of his life. Yeah, he was with his daddy, and his daddy would make sure nothing we didn’t want him having would happen, but I wanted him. Skin to skin, nursing, with Mommy. I apologized to my nurse in advance, but I was going to be a trouble patient and insist on going to the special care nursery to be with my husband and son. She went to get a wheelchair, but returned to get the bassinette. Josiah was coming back to Mommy. They said he was going to be ok. His bloodwork was fine. They did an x-ray and would bring him back to me. LJ and Josiah came back. We got a picture with Carrie, and she left shortly after. Then it was just the three of us. And I cried. God is so good!


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