Ashley Sophia’s birth story

Happy Mother’s Day!  Here’s another fantastic birth story from Kim, a mother in my due date club, this one a successful VBAC with a hospital team that was very respectful of her birth plan.  Isn’t it wonderful when that happens?  Enjoy!

___________________________________________________________________________________________________________

On August 20th, 2010, two little pink lines appeared on a pregnancy test about which I’d barely given any thought.  Mike and I had just gotten back from an anniversary trip, on which we had decided to stop trying for a 2nd baby until 2011.  We had been trying for awhile, and the monthly disappointment was becoming too much for me to handle.  I figured I was just late, not pregnant.  I can’t begin to describe the rush of excitement I felt when I saw those two lines.  After a shaky start that included low HCG levels and a blank 1st ultrasound, I finally got to see Ashley’s sweet heartbeat on an ultrasound screen at 6 weeks, 5 days.

Fast-forward to 41 weeks, 1 day…

I had irregular, but intense, contractions all day on Friday, May 13th.  Since they petered out and never got into a pattern, I chalked it up to needing to drink more water or just doing too much in anticipation of my scheduled VBAC induction on May 18th.  We had a lot to do before our baby girl arrived!  I sat on the birthing ball for a couple hours, because I figured if they happened to be real contractions (and I was convinced they were not), I might as well help things along.  Since it was Friday night, Mike and I decided to stay up and watch television – the show “Four Weddings” to be exact. He is NEVER going to let me live that down.  We normally go to bed around 9:30pm, but we ended up watching TV until 11:30pm.  Hey, it was Friday night!  We didn’t have to get up the next day.

Au contraire…

Around 3:30am, a strong contraction woke me up.  The intensity surprised me, so I glanced at the clock and made note of the time.  Of course, my “pregnancy bladder” kicked in, and I had to get up to use the bathroom.  It was then that I noticed lots of bloody show.  I decided to get back in bed and time contractions – if I had any more, which I was sure I wouldn’t because I’d been having false labor for weeks.  Sure enough, soon after getting back into bed, I had another intense contraction.  I looked at the clock, noted the time, did some difficult math (it was 3:30am!) and realized that they were 6 minutes apart.  I woke up a little more and timed contractions for the next hour.  They gradually moved from 6 minutes apart to 5 minutes apart.  At that point, I realized, OMG, this is happening – I’m going into labor ON MY OWN!  (Key since I was attempting a VBAC.)  At that point, I woke Mike up and told him that I didn’t think we’d be going to yard sales that morning.  (We had plans to walk our big community yard sale that morning.  He was so excited about it.)  By the time I took a shower and finished a little breakfast, my contractions were coming every 2-3 minutes – active labor, 3 hours after the first contraction woke me up.

After reassuring Brooke that her baby sister wasn’t hurting mommy (hard to do while breathing through a contraction at the same time), we got in the car.  We dropped Brooke off at a friend’s house and Mike made a beeline for the hospital, as my (very) vocal reactions to my contractions convinced him that this was VERY real labor and not a false alarm. On the way there, Mike mentioned that he’d forgotten the camera.  I seriously thought about telling him to turn around.

When we got to the hospital, I skipped triage and was sent directly to labor and delivery.  I also walked in under my own power!  Yes, I am proud of that!  I was at 4cm, and they started an IV so they could put in my epidural.  My OB and I had decided together that, since I was attempting a VBAC, I would get a light epidural in the (unlikely) case that I ruptured and needed an emergency repeat c-section. An hour later, my epidural was in, and 4 hours after that, I was at 7cm.  At 9cm, my water had still not broken.  They decided to break my water to encourage Ashley to come down a bit.  When they did that, they discovered thick meconium.  However, my OB said that since she wasn’t showing signs of distress, it was fine to continue (though I was ready to sign papers for the RCS, if needed).  They did decide to use an internal fetal monitor so they could more precisely monitor her heart rate.  At this point, my contractions started to slow down, and I was given 2cc of Pitocin to get things back on track.  It worked, and I went from 8cm to 10cm in an hour.

I started pushing, and just like with Brooke, I was doing a good job, but Ashley just wasn’t coming down.  When I initially considered a VBAC, I was worried that I wouldn’t be able to push through the mental block of my uterine scar and push as hard as I needed.  Turns out, that was not the case, and not that my body really gave me much of an option.  When it was time to push, it was time to push! (As I said, I had a “light” epidural in case of a rupture and emergency c-section; I could still feel everything, which is how I wanted it.)  I pushed and pushed and pushed.

Finally, after two hours of pushing, the OB said that we had to start making decisions because it didn’t appear that Ashley would be coming out without help.  He explained that since I had gotten her down to a certain point, he could use the vacuum to help me get her out the rest of the way.  If that didn’t work, I’d be taken back for a c-section.  OR, I could just choose the c-section now, though my OB strongly encouraged me to try the vacuum.

This choice was familiar, as it was the same exact choice I’d been given during Brooke’s birth.  (Then, I went with the c-section, and we discovered that Brooke’s cord was wrapped around her neck twice, preventing her from descending.)  I asked the OB about the chance of the cord around her neck, (since that could be catastrophic in a vacuum delivery) and he said he was confident that wasn’t the case, so I gave my consent to use the vacuum.  My OB explained the risks and said I’d only have 2-3 pushes to get her out, and if it didn’t work, I’d be taken back to the OR for a c-section.  So, he told me to rest through a couple contractions and to tell him when I was ready.

I rested through two contractions, and I started to feel a “big” one come on.  I told myself “you can do this,” told my OB, “let’s go,” got up on my elbows, put my chin on my chest, and pushed as hard as I could’ve ever pushed.  With that push, Ashley crowned.  I pushed again, and the rest of her came out at 6:19PM – nearly 15 hours since I’d been woken up by contractions.  I felt the ring of fire as her shoulders passed, but I didn’t care, because OMG, I just had a BABY!!!  I was immediately overwhelmed with joy and love, and started to weep at what had just happened.

My OB rushed Ashley over to the neonatologist on stand-by to check for meconium in her lungs.  A minute later, the neonatologist gave her the all clear and said, “Dad!  Get over here!”  The presence of meconium changed our birth plan so that Mike couldn’t cut the cord, but my OB had left quite a bit of the cord so that once the neonatologist gave the all-clear, Mike was called over to cut off the rest of the cord.  I thought that was such a nice gesture.

Mike took pictures (he went back to get the camera as soon as I settled into my labor room) and I watched them rub her down while I was stitched up (vacuum extractions are not kind to the mother’s body).  After they weighed her, they swaddled her and gave her to me.  All I could do was stroke her hand and say, “You’re here.  HI!”  I remember feeling like my heart would just burst when she opened her eyes and looked at me.  Everyone and everything faded to the background, and I was hers and she, mine.

Posted in Birth Stories, Good Enough to Share, Hospitals, Labor and Birth, VBAC | Leave a comment

A man’s take on breastfeeding

This story has been making the rounds, but here’s a really fantastic post on the (Wo)Men Speak Out Blog about a man’s reaction to his wife’s breastfeeding, and his eventual evolution as a man because of it.  Yes, breasts can be sexual, but they’re also incredibly functional.  He wonders if it’s our discomfort with the idea that women can be anything other than a sexual object which leads to the general discomfort that so many people seem to have with breastfeeding, and especially breastfeeding in public.  A good question, and a very good read!

Posted in Breastfeeding, Mothering, Politics | Leave a comment

Levi’s birth story

May has arrived again, it’s officially Spring, and I have lots of birth stories to share with all of you!  Most of these are contributions from women who were part of my Due Date Club last year when I was pregnant.  I wrote a little bit about this extraordinary  group of women in the preface to Sebastian’s Birth Story; we were all due in May and had exchanged beads with each other in order to make birth necklaces which we could wear in labor to remind us that we weren’t alone, even in the deepest and darkest parts of the birth.   I have since gotten to know these women much better in the intervening year and have been truly blessed by their wisdom, support, energy, understanding and mama-know-how, and now that the one year anniversary of our births is nearly upon us (or has already already arrived for some), many of these women have generously offered to share their birth stories with us here on Belly Tales. So pop some popcorn, get some tea, curl up in a comfy chair and enjoy the diverse and miraculous stories which are about to unfold.

First up is Sarah, retelling the fast, whirlwind birth of her son Levi.   (Also serving as a very potent reminder to us midwives to LISTEN to women, and never assume that just because she’s a primip, she’s going to have a long, slow labor):

___________________________________________________________________________________________________________

Saturday morning, April 30th – 38 weeks pregnant.

I insist that we have to go out and buy a toilet paper holder, towel ring, and towel rack for the bathroom we’ve been slowly renovating.  I drag Nathan around to 3 different stores before we select bathroom accessories I’m happy with, and he installs everything as soon as we get home. Everything else in the house has been ready since 37 weeks; there is even an Early-Labour To-Do List pinned to the bassinet.

Monday May 2, 2011 @ 3pm – 38 +2 weeks pregnant

I meet with my midwife Stacey for my 38 week appointment.  My blood pressure is elevated – not quite so high that we have to consult with an OB, but it’s been getting steadily higher over the last few weeks. Stacey knew I really wasn’t interested in dealing with the hospital unless absolutely necessary, and suggests that the easiest way to avoid an OB/hospital consult is for this baby to be born sooner than later.  She suggests doing a stretch & sweep today (S&S), then repeating it in a few days to hopefully get labour going prior to 40 weeks.   Because it’s my first pregnancy & I’m only 38 weeks it is unlikely that she’ll even be able to do a S&S, because my cervix is likely firm and closed.  If she can do one, she lets me know that it will probably be pretty uncomfortable and won’t likely cause anything to happen right away.  We review the risks/benefits and I decide to go ahead.  I’d been thinking about whether or not I was okay with having an internal exam at my 38 week appointment, and had decided that while I wouldn’t ask for one, if my midwife had a good reason to do one, I would be okay with it – - knowing that it only tells me what is happening in that moment, and is in no way indicative of what’s to come.

Stacey starts the exam, and we are both shocked to discover that I am already 3cm dilated & roughly 50% effaced.  She suggests that I could possibly be in early labour, and that would explain my high BP.  All that being said, neither of us anticipated that labour was imminent.  Baby was still a bit high, so she did a good ‘stretch’ but not a lot of ‘sweep’.  There was more bloody show than she anticipated as well. We decide that in addition to the stretch & sweep, I’ll start 3000mg of vaginal evening primrose oil that night, and take a dose of Caullophylum 200C.  I wasn’t interested in doing anything more intense like castor oil. I believe baby’s come when they are ready, and I didn’t want to force anything.  The S&S, homeopathics, & EPO would only help tip me over the edge if my body & baby were ready.  I know that I could walk around at 3cm for another 3 weeks… and that’s really what I expected to happen.

Over the evening I have some spotting and mild cramps that come every 20 minutes for a couple hours, but they are completely ignorable, eventually disappear, and Nathan & I head to bed.  As I drift off to sleep, I say to myself “Open for the baby.  Be open for the baby.  Surrender.”

Tuesday May 3, 2011  -  5am

I wake up to a cramp that is slightly more than the Braxton Hicks have been, and wonder if I could still be cramping from the s&s the day before. It’s so mild that I decide if it wasn’t for yesterday’s appointment I would ignore it, so I’ll just ignore it now. It goes away… but comes back a few minutes later… and a few minutes after that.  I don’t want to disturb Nathan’s sleep though, as his alarm will go off for work at 6:15am, so I commit to lying still and quiet in bed until then.  I realize that these cramps are coming every 5 minutes (I had 6 of them between when the clock chimed 5am & when it chimed 5:30am), lasting about a minute (each one lasted for 9 deep breaths, which I knew from practicing comfort measures with my clients, equalled about 1 minute for me) and they are starting to require my concentration and movement.  Still, I say nothing. I had a couple things I really wanted to finish up at work, and was thinking that I could go to work early then come home once labour picked up, if this was really it.  Then I feel a small gush similar to when your period starts, and after a couple gushes decide that I don’t want to make a mess of the bed so I’ll go to the bathroom to see what is happening.  There was lots of bloody show, so I went back to bed and woke up Nathan “Hey honey.  I don’t think you’re going to work today”.  It wasn’t just a little bit of spotting, but the kind of show you see when the cervix is making substantial change – thinking about it now, I estimate that I was maybe 5cm or so at that point.

I explained to Nathan what I was feeling, and he immediately suggested we call our doula Kim, who lives an hour away. I said that I didn’t think we needed to call her yet – this could go on for hours.  But because it was an hour away he wanted her to have enough time, so we called her from bed to give her the heads up.  I had spoken to Kim the night before to let her know about the stretch & sweep.  She told me after everything was all said & done that she knew I’d be having the baby that day, so her car was loaded & ready to go, and she had been awake since 5am that morning waiting for my call.  I tried telling Kim that there was no rush and to take her time, but by the end of the phone call I couldn’t talk through the contractions anymore so passed the phone to Nathan, who said to go ahead and come now!

I couldn’t stay in bed anymore; I needed to move, so we got up and started on the “Early Labour To Do List”.  We’d hardly get one thing started though, when another contraction would come and Nathan would have to drop everything and run to support me through it.

My contractions were now about 3-5 minutes apart, but were sometimes coming back to back, so I decided not to call Stacey yet, as I figured the double contractions indicated that baby wasn’t in an ideal position and I needed to stay upright and keep moving so that the baby could get well lined up. When contractions were more “regular” I planned to page Stacey. I started to feel nauseous and realized I hadn’t eaten so tried a bite of cracker & some ginger ale but they didn’t help.  By 7am contractions were intense.  I couldn’t walk or talk through them, they were coming every 2-3 minutes, lasting about 90 seconds, and I was moaning my way through each one saying “oh oh oh.”

I had laboured for a while in the living room, leaning over the back of the sofa, sitting on the birth ball, kneeling on the floor… but spent a lot of time in the bathroom, because I didn’t want to make a mess of the carpet in the living room and figured the bathroom would be easier to clean up.

Nathan paged Stacey to tell her it was time to come.  She asked to speak to me, and wasn’t really sure that I was in active labour.  She thought perhaps this was just cramping & spotting from the night before but I insisted that this was NOT from the S&S – this was REAL active labour.  I had a couple contractions while on the phone with her and Nathan had to take over the conversation for me. Stacey said she’d grab a bite of breakfast on her way to assess where I was at.  Kim, our doula, arrived at 7:10am – perfect timing for Nathan, who needed to finish getting the bed ready. That last contraction before Kim arrived, I think I cried through the contraction and said imploringly “Nathan…. It hurts”  (or something to that effect)  Kim walked through the door and Nathan immediately said to her “Take over!  I have to get stuff done”.  I hardly even noticed the change from one person to the next, I was so absorbed in the intensity of my contractions.

About this time I felt my first contraction with some pressure at the peak, and I found myself catching my breath. I thought to myself “Pressure doesn’t always mean pushing.  Pressure just means the baby’s head is getting lower.  Stacey is on her way anyway so no need to call her.” I didn’t say anything, just kept labouring.  I was in the bathroom, standing over the toilet and leaning against the towel rack for most of this time (Good thing we went shopping on Saturday!  Lol.)

About 7:25am I felt a trickle down my legs and realized my water had broken.  I immediately asked Kim what colour it was.  She said it was fine.  I said “No, what colour is it?”  I wanted to make sure it was clear – no meconium – because the midwives policy (as per the hospital they have privileges at)  is that you are supposed to transfer to hospital for any trace of meconium and I didn’t want to do that.  I had told Stacey that I would assess for myself whether I felt meconium (if present) warranted a transfer, since she wasn’t permitted to make that assessment anymore. I cracked my eyes open enough to check the fluid, just as Kim told me that it was clear.  Phew!

Then the contractions started to change from the hot low pain in my pelvis, to crazy intense amounts of pressure and for a few contractions, were a combination of both feelings. I cried at the peak of a contraction as I tried to cope “Kim… it hurts…” But I remembered that I needed to stay calm; to stay “low, soft, and open” and so went back to vocalizing “oh oh oh” alongside Kim.  I moved around a little in the bathroom, trying to find a position that was comfortable – no luck with that.  I asked for a hot pack which Nathan got for me but I immediately tossed it on the floor as it didn’t help at all.  Nathan tried rubbing my back but I needed his hand to just be still.  And I asked for some counterpressure on my sacrum, which Nathan gave, but I didn’t like that either.  Kim was holding me and supporting me through all this. Nothing was working.  I wanted out of our tiny bathroom.  The cool kitchen floor looked appealing, and I considered just laying down on the floor, but then the next contraction came and I leaned against the kitchen counter instead – the floor was too far down.  The counter was covered in dishes and I commented on that to Kim.  I felt so bad that the house wasn’t “ready” (ie cleaned to my standards and ready for guests). Kim said she’d wash the dishes for me when everything was over, but I didn’t hear her then.

I knew now the baby was on the way, and told Nathan “Blow up the pool!”  He raced off to do that, but by the next contraction I knew we didn’t have time to fill the pool so said “Don’t bother filling the pool Nathan!”  The pressure was so intense now, that I knew the baby was moving lower. Kim & Nathan offered to fill the bathtub instead – I declined, not wanting to create a hassle.  (Apparently they exchanged a look and began filling the tub anyway.)  And within a couple contractions I was asking if the tub was ready yet – I needed a change.  I was so desperate for water that I crawled into the tub in the middle of a contraction. My vocalizations of “oh oh oh” had changed to a more desperate “ow ow ow” mixed with crying – it was really hard to stay in control at this point.  There were only a couple inches of water, but the relief was instantaneous.

I realized that the baby was coming very quickly, and that saying “ow ow ow” through my contractions wasn’t helpful, so I switched to saying “Whoah Whoah Whoah”, to allow myself to stretch and open.  I put my hands down against my perineum through every contraction.  It helped me feel more in control of baby’s descent, as this baby was coming like a freight train.  I wanted to be sure of what I was feeling, so between contractions reached inside to see what I could feel – - only one knuckle depth in I could feel the baby’s head!!  Nathan could see hair at this point, and was preparing himself to catch if the midwives didn’t make it. I told Kim & Nathan to page Stacey back and tell her that I could feel the head so we needed Melissa too.  Melissa is the second midwife who comes for pushing and to care for the baby at birth.  Nathan skipped the paging step and called Stacey back on her cell phone.  She was just down the road from our house, so she paged Melissa as soon as she pulled in the driveway.

Then I had a contraction that I KNEW meant the baby was almost here.  Without thought or intention, my eyes flew open and I looked wildly at Kim and at Nathan.  I recognized that ‘the look’ had just happened, as I had seen so many of my clients with that same ‘look’ in their eyes.  I asked where Stacey was, and they said she was here.  Stacey didn’t really believe I was that far along yet, and was working at getting all her equipment inside.  I was asking where Stacey was, but what I meant was “Is she ready to catch this baby?” Stacey told us after that she didn’t believe I was that far along, so she wasn’t in a great hurry to get set up.  When she came into the bathroom (8am) she had the fetoscope to check the fetal heart rate, as I had declined the Doppler throughout pregnancy.  When she couldn’t find the heartrate though I told her it was okay to use the Doppler.  With the next contraction she could see how low the babies head was and said “Where do you plan on giving birth?  Because there isn’t enough water in this bathtub.”  I told her I was getting out and going to the bed to give birth.

At 8:10am I made my way from the bathroom to the bedroom, and asked for towels from the birth pool box to get laid down, as I didn’t want the sheets to get all wet and messy, even though the bed had been made up for the birth.  I got into bed as another contraction was building, and laid down on my side with Kim at my head and Nathan at my feet.  At 8:06 (tub) & 8:11(bed), Stacey checked the heart rate – 120 both times. My body was pushing, and I was still saying “whoa whoa whoa”, but I wasn’t adding any extra effort to it as I really wanted to give myself time to open.  When Stacey took the next heartrate at 8:14 it was only 70, and she asked me to push hard with the next contraction.  I thought to myself that for this stage of labour a FHR of 70 wasn’t so bad in a single contraction, and I didn’t really want to push aggressively because it might make me tear.  But I recognized that Stacey was on her own, and was probably worried about caring for both baby & I if something went wrong, so I decided I would go ahead and push with the next contraction as she had asked. Stacey also asked me to do some scalp stimulation, which I did.  My hands were down there anyway, supporting the top of my perineum as the burning was very intense at the top.  I kept saying that it hurt so much up top; that it really burned.  In that moment I was wishing for a warm compress, but I knew there wasn’t time to get one so I didn’t bother to say anything. At 8:18 Stacey wasn’t able to find the FHR, but I wasn’t concerned as I knew that was relatively common for this point in the birth.  When the next contraction came, I took a deep breath and bore down.  Because of having played a wind instrument & having vocal training, I knew how to bear down without holding my breath so that’s what I did.  (Lol. The vain part of me didn’t want to be an ugly purple pusher with bloodshot eyes & cracked lips later.)  I knew I was pushing effectively because I could feel the baby move, and the pain at the top was increasing.  I was pretty sure I was tearing, and kept my hands on my perineum for support as I pushed through it. Stacey didn’t think I was pushing though because I was still exhaling, and at 8:19 am as she looked up to tell me to push, the baby’s head, then whole body slithered out onto the bed.  Stacey unwrapped the double nuchal cord, then scooped baby up onto my belly and I held on to the new little one while I breathed a big sigh of relief: It was over!  Our baby had arrived.

I was confused at first, because I could feel two arms and two legs, but couldn’t figure out what the fifth thing was that I was feeling – then I remembered it was the umbilical cord.  Lol. After a minute or two I asked Nathan “Who do we have?”  Nathan looked “We have Levi!” Nathan cried with joy…. I closed my eyes and just rested.  After about 10 minutes Stacey was a little concerned that the placenta hadn’t delivered yet and wanted to clamp & cut the cord, and have me push.  I wasn’t having any contractions, and I really wanted to leave the cord attached until it stopped pulsing, or for 20 minutes, whichever was longer.  Stacey was nervous that blood could be pooling behind the placenta though, and wanted to deliver the placenta.  I understood that she was probably anxious about the potential of dealing with a hemorrhage on her own so I agreed to let the cord be clamped & cut, and to push out the placenta while she assisted with gentle traction.  Because I didn’t have any contractions I had to make more of an effort to push.  Kim put her arms behind my head to help me curl up a little and push, while Stacey worked the placenta out.  I felt it release and said aloud that it had released.  The placenta was very small but healthy, and it was birthed at 8:37pm – 18 minutes after the birth.  Stacey & Kim bagged it up for me and stored it in the fridge so I could encapsulate it later.  Melissa arrived at 8:40am, and after getting acquainted with everyone did the newborn exam while Stacey put in some labial stitches.  My perineum was intact, but my labia had a small first degree tear at the top (where I had felt all the burning).  Once that was all done we got settled into breastfeeding, snuggling, and meeting baby Levi;  Kim went out to clean up the bathroom, do the dishes I’d been worried about, and get our prepared food out of the freezer; the midwives did their paperwork.    Melissa left at 10:20am, and Stacey left about 11am.  Nathan asked Kim to stay a little longer – she was with us until about 1pm.  Nathan, Levi & I cuddled in bed as a new little family for the next hour, before we started making phone calls to family & friends.  It was a whirlwind!  But all was well.

 

Posted in Birth Stories, Good Enough to Share, Homebirth | Leave a comment

Holy Work

I’ve been reading a lot of birth poetry lately.  For reasons which I can’t quite yet delve into in this moment (still keeping things on the down-low, if you know what I mean), I’ve been revisiting my calling to midwifery, and finding that it is still singing it’s siren song, as strong as ever as I begin to explore new paths.  Renewed, revitalized, I’ve been posting pictures to pinterest which move to my very soul, and have been finding poetry which does the same.  There are two amazing poems I wanted to share here.  When I first began my journey as a new midwife, my midwifery classmates and I performed a Hand Blessing ceremony, and I dedicated my hands to doing the work of the Goddess on this earthly plane,  helping mothers to bring new life into the world.  Some days, in the hospital, it’s so easy to forget, which is where the poetry comes in to play as a gentle reminder to NEVER forget: we are doing holy work.  To stand at the entrance, at the very gate of life, in that moment where the veil between the worlds is thin and a new soul is manifesting–to stand with a woman as she digs deeper than she has ever dug before, breaking down the very core of her identity until she can’t even remember who she is, only to rebuild herself again the instant that she gives birth not only as a woman but as a mother–to watch her do this, and support her through it–this is holy, indeed.  Below are two poems which I feel express this very thing so perfectly they made me both cry.  Enjoy!

Incarnation, by BlissRipple

My prayer was, “Help me,
Help me,”
prayed to Him—
the Emerging.
Knees bent, pooled in water,
arms pressed hard against
the smooth white-wall
before me.

Back-arched & aching, thighs shaking
with one last guttural hum,
Ohm Shakti
Ohmmmmm.

The thick velvet veil was torn.
That bathtub was transformed
into the Holiest of Holies.

Down He rode in His chariot of fire,
a crimson wave
of red sea parted.
My God,
blue as Krishna,
to lay idol heavy
upon my chest,
flush pink and heaving.

Rose raindrops streak
ivory pillars now stilled
from the quaking.
At their arch evidence
of His exalted exodus.

He who delivered me,
carried me to the gates of Isis
and scrawled “Mother” across
my bearing  breasts.

From that labyrinth belly
I emerged
my inner chambers bare.
And on the platter of my chest
the bearer of first communion served
salted milk— in the robes
from which we came:
Nakedness.

___________________________________________________________________________________________________________

Blessed Be, by Leigh Steele (author of This Holy Work, which is where I was most recently reminded again of the holiness of what we do)

If you’ve ever wondered what it looks like to see a poem write itself, kneel on a warm floor and watch a mother unfurl herself to make way for the passage of her baby.

If you’ve ever pondered what a poem sounds like, close your eyes and listen to the song that fills every empty space in a room as a woman rains down her tune in birth.

If you’ve ever wondered how a poem moves from stanza to stanza, then pull up a chair to the wild eyes behind the sweaty hair of a maiden morphing into a mother.

And if, by chance, you’ve ever wondered what a poem tasted like on your tongue, kiss the head of a babe fresh from from the womb and then the temple of the woman who just brought her forth.

If you’ve ever thought about what it means for the invited to be the one serving, sit on your hands and see if you can hold back tears at the image of a woman standing in her own circle of power.

Blessed be this holy work that has allowed me tender entry.

Posted in Birth Art, Good Enough to Share, Labor and Birth, Myth, Folklore and Ritual | Leave a comment

The history of Planned Parenthood

This is a few weeks old, but it’s absolutely fascinating: Jill Lapore’s article Birthright: What’s next for Planned Parenthood in the New Yorker chronicling the history of  Planned Parenthood and the birth control movement, and how that movement became politicized, and then later violently attacked, and now so deeply partisan and entrenched in the public consciousness that it seems we’ll never be able to get around it.  So many very vocal critics have gotten its history so wrong. Amazingly, the history of Planned Parenthood itself has never been written, although histories of many of its founders and leaders have.  In order to write the article, Ms. Lapore had to go through the archives at the Library of Congress (where Margaret Sanger’s papers reside), Smith College (which houses Planned Parenthood Federation’s records), the Houghton Library at Harvard (home to the records of the American Birth Control league, which later became Planned Parenthood), and Radcliffe’s Schlesinger Library for the History of American Women.  Ms. Lapore’s journey is chronicled in some amazing photos which are also up in a slideshow at the New Yorker.

When members of Congress (i.e. Rep. Tom Price) can say with a straight face that “there’s not one woman” who can’t afford her birth control in the country right now, it’s amazing to discover that it was actually Republicans who were some of the staunchest supporters of federally funding birth control clinics in the beginning.

Here is where we are. Republicans established the very federal family-planning programs that Republican members of Congress and the G.O.P.’s Presidential candidates are this year pledging so vigorously to dismantle. Republicans made abortion a partisan issue—contorted the G.O.P. to mold itself around this issue—but Democrats allowed their party to be defined by it. And, as long as Planned Parenthood hitches itself to the Democratic Party, and it’s hard to see what choice it has, its fortunes will rise and fall—its clinic doors will open and shut—with the power of the Party. Much of the left, reduced to a state of timidity in the terrible, violent wake of Roe, has stopped talking about rights, poverty, decency, equality, sex, and even history, thereby ceding talk of those things to the right. Planned Parenthood, a health-care provider, has good reason to talk about women’s health. But, even outside this struggle, “health” has become the proxy for a liberal set of values about our common humanity. And it is entirely insufficient

It’s good to be reminded of the real history, whether you’re pro-choice or pro-life.

 

Posted in Choice, Contraception, Feminism, Politics, Women's Health | Leave a comment

Ina May in the Sun

The Sun Magazine has a fantastic article in their current issue (Jan. 2012) interviewing Ina May, who’s recently come out with a new book Birth Matters: A Midwife’s Manifesta, about the medicalization of birth.   While the online version of the article is truncated, it’s still a fascinating read, complete with the history of how and why vaginal breech births fell out of practice (as dictated by insurance companies, no less!  I had no idea!).  Nothing earth shattering, but Ina May is always concise and insightful, and always, always a good read.  Enjoy!

Posted in Homebirth, Labor and Birth, Midwifery, Vaginal Birth | Leave a comment

The 10 Commandments of Getting Pregnant

This was shared with me, I felt compelled to share it all with you.  Totally cracked me up, but SO TRUE!!!!

Getting Pregnant with LumaLoveGettingPregnant.com
Posted in Fertility and Conception, Pregnancy | Leave a comment

Experience and Personal Practice

Personal experience always changes the way you practice in some way.  Anyone who denies this is probably not being 100% honest with themselves.  It’s the nature of us being human, and it’s inevitable because humans (as opposed to future robots?) provide health care, and by and large it’s a very good thing.  This can be seen most obviously because of bad outcomes, which I admit can be a very compelling reason to change your practice.  You see something terrible happen once, and after that, you’re more cautious as a provider.  Sometimes this means you call a cesarean sooner than you would have in the past (if you’re a doctor), or you start antibiotics a bit sooner, or call Peds to a birth which before you would have handled on your own.   And usually it’s like a pendulum, swinging back and forth.  Initially, after a scary experience or bad outcome, you will become overly-cautious and hyper-vigilant, and then, with time, as you see similar situations which result in good outcomes rather than bad, you begin to calm down a bit about whatever it was which was making you so nervous in the first place, and regain your perspective.  It’s not that you eventually grow lax or complacent over time, but more that gradually the personal experience gets integrated into your practice as a whole, so that you’re no longer fearful of it, and yet you have that past experience as part of your wealth of knowledge to draw from the next time you’re facing a similar situation.  It’s small things, like remembering to have a woman pee or empty her bladder before pushing because of that one time when a full bladder caused a postpartum hemorrhage.  In this way, we learn from the mistakes we make and the occasional bad outcome which occurs, and in most cases this makes us better providers

As an example, very recently for me I had a baby who needed full-on resuscitation after the delivery, and I was absolutely shocked and baffled by it.  It was a full term baby, we’d been continuously monitoring the heart the entire time she was pushing and everything was looking good (up to the last few minutes when the baby slipped under the pubic bone and it become incredibly hard to pick up the fetal heart rate…and granted, a few minutes can make a big difference if the baby’s heart rate was decelerated during those minutes, but overall the tracing had been very reassuring).  She wasn’t even pushing for that long, you would expect everything to turn out well, or at least expect the baby to pick up very quickly after some drying and stimulating….and yet, shockingly, the baby came out blue and needed not just positive pressure ventilation with a bag and mask, but chest compressions as well (which you only have to do if the fetal heart is less than 60 and isn’t picking up, and which most babies rarely ever, EVER need; prior to this delivery, I had seen chest compressions done only two other times in my 8 year career as a Labor & Delivery nurse and now midwife).  The Apgars for this baby were 1 at one minute of life (which means the baby had a pulse, and that was it), 4 at five minutes, and 7 at 10 minutes (which is certainly a decent enough score, if not absolutely perfect).   It was a full three minutes before the Peds team arrived on the scene; I was ventilating the baby while the nurse did chest compressions.  And thankfully, in the end everything turned out well; we resuscitated the baby, the baby recovered nicely and went home two days later perfectly normal, but nevertheless, it was absolutely terrifying.  Afterwards, as we were recovering and debriefing and waiting for our own heart rates to return to normal, the only issue we could see was that the mother had had chorioamnionitis (an infection of the amniotic cavity), and one of the attendings pointed out that he has sometimes seen chorio do that to a baby before.  It wasn’t something I had ever seen before, and chorio had never been something I had routinely called pediatricians to a delivery for in the past, but now it gave me pause.  And the next time I had a woman pushing with chorio (only about a week later), you can be damn sure I called Peds to the delivery, well before the baby actually came out.  With that birth, everything was fine, the baby was pink and vigorous with Apgars of 9/9, and the pediatricians were  wondering why I had called them for something as routine as chorio.  I called because personal experience had made me cautious, and has temporarily changed the way I practice.  The next time I am pushing with a woman who has chorio, I may decide to call Peds again, or maybe I will decide to wait and see.  I suspect that gradually over time it will become less scary again, and become more integrated into my overall practice, but I will always and forever add chorio to my mental check-list of reasons why we may need Peds at a delivery, and will probably make the call based on several factors, like 1) how long has she had chorio, 2) how long has she been pushing, 3) how has the tracing been overall, 4) how high has her fever been etc. etc.   And a full-on resuscitation is now always going to be one of the possibilities I consider with a woman who has chorio (although technically it’s something we’re supposed to always consider with every delivery, and it can and does happen out of the blue sometimes for no apparent reason at all); always, always, from here on out.

But personal experience isn’t always negative, or built upon bad outcomes and our responses to them.  I was writing to a friend the other day about how my practice as a midwife has changed now that I’ve given birth myself, and I also find this very interesting to stop and reflect on a bit.  The most obvious change I can think of is how I handle women in early labor/ prodromal labor. This comes from my own experience of an endless early labor which lasted for nearly 2 days.  I think in the past I was a bit more terse with women coming in to the hospital in early labor, only to be sent home again because they were only 1 or 2 centimeters dilated.  They weren’t in active labor yet, and that was that.  Which isn’t to say I wasn’t sympathetic and sweet about it, but I didn’t spend nearly as much time talking with and encouraging these women as I do now.  Now my heart goes out to them so completely because I can so well remember what that’s like.  It’s not like my contractions were irregular and mild—they were strong and regular and painful to me, at the time.  Albeit they were nothing compared to the contractions that were yet to come, but since it was my first time laboring, I had no idea of what was yet to come, and in the beginning, the early labor contractions were PAINFUL.  I spend so much more time with these women than I ever did before in triage, going through what’s normal and what’s not, reassuring them, talking about what (limited, because nothing really helps that much) comfort techniques they have at their disposal.  I’m even more patient with them, and even more understanding.  In this regard, I think empathy is quite valuable–which isn’t to say that you can’t be a good provider if you haven’t gone through it yourself—but I do think it adds another layer to my care which wasn’t there before.

Strangely enough, though, if I’ve become much more patient with women in early labor, I’ve become much more practical and maybe even a bit tougher when it comes to second stage.  In the past, having never pushed a baby out before, and having no idea what that actually felt like, I was incredibly sympathetic to the agonies of pushing.  I would allow women to say things like “I can’t” again and again during pushing while I calmly and unflaggingly told them again and again and again that they could.  For me, this was the epitome of midwifery care—this spoke to the very root of my calling, helping women to find their own strength in the moments when they were convinced that they had no strength left, helping women to climb the mountain that they thought they couldn’t climb.  However, having now pushed out a baby myself, I feel like I cut to the chase much more quickly during the pushing phase than I ever used to in the past.  I can remember just how excruciating the pushing was, and I know all too well that there’s no cure for the pain except to GET THE KID OUT, and I no longer hesitate to use tough love to help women buck up and PUSH, or hunker down and PUSH, or get to work and PUSH, if it seems like that is appropriate and will be effective.  It’s become another tool in my arsenal.

Granted, there is a time and place for everything, and there are certainly some women who will always need a softer touch, and as a midwife you are always acting like a chameleon; in a way, that’s the hallmark of what good midwifery care is.  Because women are so different and because labors are so different, what works in one situation doesn’t work in another situation. There is no cross-the-board answer.  I can get away with saying something with one woman which I would never dream of uttering with another woman,  based on my personal relationship with that woman, and on who she is and on what is needed minute by minute.  And often the situation itself dictates the tone; sometimes the energy in the room is very high, and you can joke around and be loud and loving and teasing, other times the mood is very subdued and quiet and she is working hard and inwardly focused, and what is needed is a soft touch or a single word.  You have to know how to surf the different energies at different times.  But now, thanks to my own personal experience of birth, I try to get women through second stage as efficiently as possible, to try to keep the pain from being drawn out longer than it needs to be.  Because man oh man is it painful!

Experience can be both a blessing and a curse, but it’s all of these little moments strung together which makes you a better provider.  This is the reason you seek out providers who’ve been doing this for awhile, who’ve seen the good, the bad and the messy, and have learned how to integrate it into their larger view.  For all my midwife sisters out there, how has your personal experience changed you?

Posted in Complications, Hospitals, Labor and Birth, Labor Support, Midwifery, Vaginal Birth | Leave a comment

Question Kegels?

One of my pregnant patients was asking me the other day about what your vagina is like after giving birth.  I reassured her that the tissue of the vagina and the perineum usually comes together very easily after a delivery, even if she tore, and that the perineum usually heals beautifully after a birth (a midwife preceptor used to joke that if there are two pieces of a perineum in a room they will find each other and stick together, such is the beauty of it).  However, I admitted that the muscles of the vagina are another story altogether, and that rarely do these muscles function again exactly as they did before you give birth without a some (sometimes a great deal of) effort on your part.  And I am personally a perfect example of this.  Let’s just say that even now, 6 months postpartum, things are still not at all what they once were in terms of my pelvic floor.  I guess this is what happens when a baby is crowning for an HOUR and those poor muscles (the bulbocavernosous in particular, I think) get incredibly, incredibly stretched out.  And yay, I didn’t tear, but man oh man–I sort of think I would have happily tore instead if it meant my muscles were just a bit stronger and less stretched out now.  I don’t really want to get into graphic details, but let’s just say that I still have a lot of work to do to avoid having both a cystocele and a rectocele for the rest of my life!

While researching this on the internet, I’ve stumbled upon some fascinating information which flies in the face of conventional wisdom.  Conventional wisdom suggests that kegel exercises are the answer to this sort of pelvic floor weakening problem, and in fact they’re what I have been doing primarily, and have been teaching my patients how to do for years now.  Kegels, kegels, kegels!  However, after reading this amazing post over on MamaSweat where Kara Thom of MamaSweat interviews Katy Bowman of Aligned and Well, I am beginning to change my mind.  Katy is a biomechanical scientist who has done a lot of research into the mechanics of the pelvic floor, and in her radical departure from conventional wisdom, she suggests that squats are the answer rather than kegels.  Naturally, rocking the boat like this has brought with it a bit of a back lash, including this hilarious video aimed at Katy from the “Kegel Queen” (an RN who also believes highly in the merits of kegels); even a year after the initial interview, the debate is still alive and well.

So in addition to kegels, I’ve decided to add some squats to the mix, and I’m even squatting and peeing in the shower each morning (apologize for the potential TMI right there, loyal readers!).  There are also some pretty cool exercise systems out there which can be purchased, as well as physical therapists who specialize in nothing but the pelvic floor, so I’ll keep all of you posted on pelvic progress 6 months from now.  But I’m also a firm believer in sexercises, too!

Posted in Gynecology, Miscellaneous, Postpartum, Research, Women's Health | 1 Comment

Cooking with Milk

So, my darling boy is nearly six months, which means that solid foods are just around the corner. In preparation for this, I’ve begun to research which foods we should start him out with, baby food in general. Our pediatrician, while incredibly open-minded and holistic in other areas, has actually proved to be a bit conservative in his recommendation of starting off with rice cereal as the very first food. There are some pediatricians which are launching spirited campaigns against cereal as the first food, arguing that it’s just refined carbs, the equivalent of white-bread, and that this trend may actually promote childhood obesity.   So instead of going that route, I’ve decided to try my hand at cooking my own baby food instead.  Armed with a few books (this one, this one, and of course, this one, not to mention this wonderful website) and a bunch of cute plastic freezer cubes, I’ve begun making my own baby food!  On Saturday I made a banana puree which involved sauteing chopped banana in butter and then mashing it.  Quite yummy, reminded my of banana fosters!  Yesterday I baked a sweet potato and then blended it up with….breastmilk.  Yes, it turns out that most of these recipes call for breastmilk, which makes sense given that breastmilk is what the baby has been eating 24/7 up until now, and is still a complete meal in and of itself, full of iron, antibodies and every other necessary nutrient under the sun.  But when I started out on this parenting journey, I never imagined I’d find myself leaning over a blender with my bra down, adding a few squirts to a potato puree in order to get the consistency right.  Wow.  What next?  Guess we’re really cooking with gas milk now.

Posted in Mothering | 2 Comments