Belly Tales

This beautiful birth happened right here in NYC, with a NYC-based homebirth midwife. Thank you so much for sharing your birth story with us!!

There was nothing in the classes that we both took leading up to the birth that could have prepared us for the overwhelming experience of our home birth. It was truly amazing.

I want to say a word about the courage and strength of my wife, Maryann*. She was incredible. I’ve never seen strength displayed in such a raw and powerful way as I saw Maryann display in this birth. Her efforts were a reflection of the kind of person she is. She was tenacious and determined. I was in awe of her for the entire five hours.

In the classes we took leading up to the birth, they talked about pre-labor. This was supposed to be a time to take a walk, bake some cookies, quietly prepare the birth tub, and slow dance through the first hours of light contractions. At 2:20 AM Maryann woke me up and she was in full active labor. There was no time for walks or dances and there certainly wasn’t going to be any cookies. My plan of having time to gather myself and mentally prepare for the hard work ahead was out the door replaced with Maryann’s pain and a frantic effort to try to time the contractions.

We ran the bathroom tub so that Maryann could get into the water while I began to fill the birth tub in the living room with the hose. At this point her contractions were four minutes apart, already very intense and lasting 45 seconds to just over a minute. After about an hour, the living room birth tub was filled and Maryann settled in for the rest of the birth. Natalie* (the doula) and Madeleine* (the midwife) arrived around 3:30AM just as Maryann’s contractions were increasing in intensity. Madeleine was great in her ability to reassure Maryann about what was happening and how great she was doing. She encouraged Maryann to feel her cervix so that she could touch her own progress as it was happening. This was effective for Maryann, as she felt empowered to continue making progress.

At about 5:30 AM Madeleine helped push the cervix up over the baby’s head, and it was time for Maryann to start the process of using the contractions to push. The pushing was very difficult and painful, but Maryann was a real champ. She didn’t shy away from the process and at 7:40 our son was born. He slipped into the water and into our arms and we were immediately in love. The best part about having the home birth was the fact that we were able to immediately hold our baby and spend time with him. We lay in our bed together as a family only minutes after he was born. It was an incredible feeling!

And now, the thank you’s: Madeleine, you truly are a hero. You were so perfect throughout the process. I couldn’t imagine having the baby without you there. Maryann can’t stop talking about how great you were, and I wholeheartedly agree.

Natalie, you came to our aid and support without hesitation, and I am so thankful for that. Your words of encouragement and steady hand throughout the birth were a key factor in Michelle’s success. Not to mention the video you took. Absolutely beautiful! You have many gifts, and your photographic eye is one of them.

Thank you to each of you who held us up in prayer in the days and weeks leading up to the birth. We are truly grateful for your thoughts and prayers.

Wow, just read a brutally blunt article over at the Tennessee Guerilla Women website that really lays into the morality of forcing women to have unwanted babies in a society that is anti-family, anti-health and anti-life (and no, not life as in pro-life, but anti-living well and healthy, on every level: physical, emotional, spiritual etc.). Tennessee Guerilla Women tell it like it is!

“There is nothing “pro-life” about a nation that has the highest child poverty rate in the developed world. If the goal is to persuade American women to give birth to more children, this nation is going to have to join the rest of the developed world and get serious about coughing up a pro-family, pro-life policy.”

In a valiant attempt to work myself into a limp and bloody pulp, I decided to go to work last night because they were understaffed and desperate for an extra nurse, and were begging and pleading, and I thought that even though I had already spent 8 hours on my feet all day doing clinicals, working another 12 hours probably wouldn’t kill me. In retrospect, this probably wasn’t the wisest decision I’ve ever made, although I did survive the night. Our unit was absolutely slammed, and none of us got breaks, and by the end of the night (well, the early morning of today), I was bleary-eyed, and double-checking everything I was doing because I was certain that I was bound to make a mistake from being so tired. How do residents do it? Or midwives on call who have back to back delivieries?? Yikes.

I ended up having three patients and two deliveries: one cesarean birth, and one vaginal delivery. My third woman was an induction for Premature Rupture of Membranes, aka PROM (a subject which has become very close to my heart, as my research proposal is on this topic); she was on pitocin, but she wasn’t progressing that quickly, and didn’t deliver during my shift. The vaginal delivery was the most fun. The woman came in at 4:15 panting and moaning. The initial exam found that she was 5-6 centimeters dilated at that time. It was her second child, and her first labor had only lasted 3 hours, so we were definitely scrambling to get a room ready. We didn’t even have a completely clean room to put her in, given that we ended up having 12 deliveries last night and we didn’t have a nurses’ aid, either, to help us get the rooms ready, so another nurse and I ended up swapping out the dirty bed in her room for a clean bed which we prepared in the hallway. We got her into the room, started an IV on her and gave her Penicillin because she was GBS positive—this was finished by 4:32 am. She was begging for an epidural, but she didn’t have time, given that she was fully dilated by 4:35 am. The baby was born at 4:39 am, after three pushes. It was all so lightning fast: first an IV, then, the next thing we knew, her water broke, then the doctor was shouting for a table, and boom, I had just gotten the oxygen and suction hooked up for the arrival of the baby, and the baby was out and screaming before I’d even turned around. Now that’s the way to give birth! What a crazy, fun, awesome precipitous delivery. Afterwards, I told the woman that she was just amazing, super strong, and then casually observed that obviously she didn’t really need that epidural after all, and she agreed with me, and said that next time, she wasn’t going to ask for one, she was just going to have her baby instead.

Mwuahahahahaha. Subversive midwifery at work! Any day I can gently convince a woman that she doesn’t actually need an epidural is a good day, indeed.

At certain points throughout the night, I just kept thinking in disbelief that only that morning, I had been doing speculum exams on women at the Family Planning clinic, and inserting an IUD. It seemed like a lifetime ago. I thought of all the women and vulvas I had seen in the past 20 hours, and was rather stunned (but pleased) by how high the number was. That’s a lot of women! Although, given how exhausted I was by the end of my shift, if work ever tries to call me in again after a day of clinicals, the answer will be a resounding NO!!

I inserted my first IUD today! I did it mostly on my own, with my preceptor checking my sounding and talking me through the procedure, and I was amazed by how simple it was. After learning all of the steps in school, and being tested on them during our IUD check-outs, it seemed like a much bigger deal than it actually was. And thankfully, there were no tenaculums involved. Instead, the clinic uses Allis tissue forceps in place of tenaculums, which was a little bit less intimidating. Basically, the prongs of the Allis are placed at the 11 O’Clock and 1 O’Clock position at the very top of the cervix, and then the axis of the cervix is gently straightened out for the insertion. Both the uterine sound and the IUD itself just slipped right in! I was amazed. Of course, it didn’t hurt that the woman we were inserting the IUD into had had six kids, and 2 previous IUDs, her last one in for 10 years. She was a big fan of them, actually, and was so gentle with me. Having had the procedure done two times prior to my insertion, she knew what to expect, and didn’t need much calming or reassuring—in fact, she was reassuring me! Funny how the one thing I was feeling particularly squeamish about ends up being one of the very first things I end up doing. And you know what? It really wasn’t that bad at all. I wasn’t as nervous as I thought I’d be. My hands weren’t even shaking—in fact, my preceptor told me that I had good hands during the procedure. What a compliment! She also mentioned that there are usually two or three IUD insertions a day to do at this clinic, and promised me that next week I’d do more. How exciting. I’m really looking forward to getting good at the technique, and feeling confident about it.

I only saw 4 patients, but two of them were annual exams, which were long and involved and fun. One woman was here because of the IUD, and one woman was here for a Depo Provera shot. I got to write a nice long SOAP note, and do full exams on the women. Lots of practice inserting speculums, and collecting specimens. We even looked at slides under the microscope again to determine that one of the women did indeed have a yeast infection. My preceptor was a lot of fun to work with today, too. She was the smiley one, and this time, instead of letting me go off on my own, she kept closer tabs on me, which I was really appreciative of. What a great day in Family Planning! I hope most of my clinical rotations are this much fun.

This didn’t take long at all. South Dakota is already challening Roe v. Wade. In a very scary vote today, the South Dakota Senate passed a bill banning all forms of abortion, except those necessary to save a woman’s life.

“After more than an hour of fierce and emotional debate, the senators rejected pleas to add exceptions for incest or rape or for the health of the pregnant woman and instead voted, 23 to 12, to outlaw all abortions, except those to save the woman’s life.

They also rejected an effort to allow South Dakotans to decide the question in a referendum and an effort to prevent state tax dollars from financing what is certain to be a long and expensive court battle.

This is beyond ludicrous. I guess it was only a matter of time once our Supreme Court took it’s terrifying plunge into abject conservatism, in a country where even the concept of birth control is becoming sketchier and sketchier in our abstinence-only society…but sweet gaia mother of all…I didn’t think it would happen so quickly.

Now, the only thing this new law is waiting for is the signature of the Pro-Life Governor Mike Rounds.

I’m not a lawyer, but I do believe that at this point, even if this South Dakota bill does get signed into law, it’s still illegal because it’s outside the bounds of Roe v. Wade and Planned Parenthood v. Casey. To quote from the Washington Post article on the subject:

“If you’re just reading the law as it stands now, South Dakota’s law doesn’t really stand any chance under Roe or Casey . I have to agree with those who think it’s remote,” said Chuck Donovan, executive vice president of the Family Research Council and a former lobbyist for the National Right to Life Committee.

However, the The Supreme Court has already begun to reconsider abortion legislature, choosing to re-examine the constitutionality of the Partial-Birth Abortion Ban of 2003. To quote Nancy Keenan, President of NARAL Pro-Choice America:

“The two main reasons Courts have struck down these bans are: their broad language could ban abortion as early as the 12th week in pregnancy, and they lack exceptions to protect women’s health. Medical groups, including the American college of Obstetricians and Gynecologists, oppose the federal ban.

Today’s action means the core principle of protecting women’s health as guaranteed by Roe v. Wade is in clear and present danger.”

If you believe in women’s reproductive rights, if you believe women should have access to birth control, if you believe that the very private and personal decision of whether or not to continue a pregnancy is something that should be made by the individual couple or woman involved, and not by our government, if you believe that laws should protect the constitutional rights of its citizens by protecting their personal liberties, if you believe that women should have the right to choose whether or not to continue a pregnancy, if you believe that women have the right to safe, clean, medical abortions, and not back-alley care…join NARAL Pro-Choice right now and give them money so that they can fight for what you believe in.

Well, I didn’t exactly get thrown into the deep end, but I wasn’t eased in quite as gently as I might have hoped, either—so I guess, all things being equal, my first day of clinicals certainly could have been much worse. I met my preceptors, and they both sort of threw me for a loop. The first one is very no-nonsense and to the point (although very very efficient and thorough); she didn’t smile much, and was definitely somewhat intimidating at first, until I got to know her a bit better. The second one was very gentle and soft-spoken and full of smiles. They both had very different teaching styles. My first preceptor carefully explained each patient to me before I met her: we went over labs, she walked me through the documentation, highlighted important areas that I had to discuss with the patient, and basically helped guide me through the management process. She was also very willing to let me shadow her for a few patients, and join her in whatever room she was in. My second preceptor would say things like “how about doing that new OB admission in room 3?” and would then leave me to it, although she was always very patient with me whenever I asked her questions, which was almost all the time. I guess, on my very first day of clinicals, a little bit of both methods of precepting was probably a good thing.

And what a first day! I saw 7-8 revisits (i.e. women coming in for follow-up appointments after their intitial prenatal visit), did one initial visit pretty much entirely on my own (and oh boy, all the mistakes I made!), and finished up with one postpartum visit. It seemed like an incredibly full day. So many fundal height measurements, and Leopold’s manueavers (which I’m getting much better at—I was actually able to tell when the baby’s heads were down, by the end of the day, and I got to feel what “balloteable” feels like, when the baby’s head is down, but not yet engaged), and so many gorgeous, gorgeous bellies, and little squirmy babies that would move beneath your hands while you were palpating. And I was absolutely amazed by the diversity of patients I saw: it would seem that the Bronx, even more than Manhattan, is a microcosm of the entire world. So few of my patients spoke English as their primary language. I saw one woman from Albania, with her two adoreable kids in tow, and one woman from Bangladesh, in a gorgeous silk sari with all kinds of spangles and bangles and beads on it, bracelets up to her elbows, enormous jeweled tear-drop earrings, and a jewel-studded nose-ring, and this was just her average, every-day wear. I saw a woman from Mali who only spoke French, and I ended up having to use an interpreter through the phone bank in order to talk with her. She was absolutely gorgeous, tall and ebony black, with enormous silver earrings, and short-cropped hair, and a large scarf wound around her head, and a beautiful, proud pregnant belly. I saw a woman from Pakistan who wafted a delicious curry smell through the room every time she moved, and was wearing a sari made of curdoroy. Two Latina women, one of whom (my initial OB intake that I was doing on my own) only spoke Spanish. There was also a Jamaican, and two African Americans, one a devout muslim in full burka. What a roster! I felt like the entire world was parading through the door.

So few of these women have health insurance. One or two had only just arrived in this country. Almost all of them were on WIC. One was convinced that the reason she’d miscarried her first child was because she’d bounced over too many potholes in a rickshaw in her home country. One was terrified about her risk for cervical cancer, because she’d only just learned that she’d had an abnormal pap. One was told, for the very first time, that she was Hepatitis B positive. One told me that her boyfriend had just recently hit her for the very first time ever while she was holding their baby, and that she’d fallen flat on her back in order to protect the baby. She’d called the police; she wasn’t pressing charges, although the ACS (Administration for Children’s Services, the child protection program in NYS) was now inovlved. We talked about whether she felt safe or not, how she could protect herself and her baby, what resources she could use if it ever happens again, and that if her boyfriend is capable of hitting her once, chances are very good that he will be capable of hitting her again.

Afterwards, overwhelmed and exhausted, I feel a bit stunned. And amazed. Funny how so much of my experience with midwifery so far has been helping one very specific population of women—a population for whom having a midwife, and a doula, and a delicious, natural childbirth is very much a luxury, reserved for women with insurance, and the education to know that they want that kind of birth in the first place, and the money to afford doulas, and birthing balls, and private midwives. However, there is another side to midwifery, with which I’ve had very little experience so far: the side that takes care of the women without health insurance, without disposable income, with children in tow, for whom natural childbirth isn’t a luxury, but a reality, because you can bet your bottom dollar that these women without health insurance, and without private doctors, aren’t going to end up with cesareans unless they really, truly, need one. It’s so heartening to see that these women also have access to midwifery care, which, in my most humble opinion, is the best kind of care out there—the best of both worlds.

And I bet for many of these women, going to see a midwife feels so much more natural than going to see a doctor for their prenatal care, anyway. Who attends most of the births in Mali? I bet you anything it’s not a board-certified obstetrician.

I have a feeling I’m going to learn so much from my clinicals, and not just how to manage prenatals, or do a good bimanual exam! And I’m really looking forward to Friday’s clinicals, where I’ll be working in Family Planning. The nerves have somewhat dissipated, although I know I still have a long way to go.

So, just a quick update on the clinical front. I went up to my clinical site again last Thursday to take the policies and procedure course (taught by Ms. V, and honestly, very well done—these classes are always a bit of a chore, but she was brisk and humorous and helped us zero in on exactly what we needed to know for the exam at the end…and amazingly, she managed to get the entire class done in 3.5 hours!). And, after a few rounds of phonecalls between my program director, the clinical coordinator at my school, and Ms. V, which culminated in my school faxing a copy of my malpractice insurance to Ms. V, I was finally able to get my security clearance!! Thank goodness that’s done! However, I haven’t yet taken my computer class. Nor have I been able to get my ID card, because when I went up to the hospital again on Friday to go to the security office, I learned (much to my complete and total annoyance) that the ID machine was *broken*. Bah. Three cheers for yet another unecessary 2 hour commute to the Bronx.

Nevertheless, all is in good standing, and I will finally be starting my clinicals tomorrow. To say that I am nervous is a bit of an understatement. I’ve been panicking at random moments throughout the day and grilling myself with questions that I know I knew at some point, but have since forgotten the answers to, such as: exactly how much weight pregnant women are supposed to gain every week during each trimester, and exactly how many micrograms of Vitamin A is necessary for proper nutrition (and how many micrograms is too much), and Vitamin C, and folic acid, and calcium, and Iron, and what’s the normal hematocrit and hemoglobin for pregnant women during each trimester, and if a woman has a yeast infection, exactly what do I prescribe, and at how many weeks gestation does the fundal height begin to correlate to the number of weeks she’s been pregnant (22 weeks or 24 weeks?), and what’s the MSAFP test for, and what’s a normal glucose tolerance test result, and what screening tests are re-done at 28 weeks? Aaaaaaaah!

I feel like I don’t know anything, and I am rather petrified, because tomorrow I’m going to have a white coat on, and be talking with pregnant women who are going to see that white coat and think that I have a clue, when really, I don’t. The very thought leaves me cold. I was up until 2:00 am last night cramming, and the rest of tonight is going to be devoted to cramming as well, and putting the final touches on my “little black book” (my cheat sheet book, aka my peripheral brain, as one of our professors called it). All I can say is: I really hope my preceptors are nurturing and patient, and willing to let me shadow them for a day or two before throwing me into rooms by myself.

I’ve been working the past two nights, and absolutely loving it, actually. I’ve been on Postpartum, and have just had a lovely crop of women to take care of. Sadly, at my hospital, most women tend to keep their babies in the nursery all night, despite my best efforts to encourage rooming-in. And sadly, breastfeeding is not necessarily the standard, either; there are always a lot of women who choose to bottle feed, for so many different reasons, and while I am always very respectful of their decision, I always feel a bit sad about it. However, the past two nights, I have been very lucky—almost every one of my 8 patients was breastfeeding, or attempting to breastfeed, or else very eager to breastfeed, and desperately wanting to start just as soon as their baby gets out of the NICU. It was heavenly, and so much fun, although incredibly time consuming. There was also one room in particular where both women had chosen to room-in with their babies, and both were breastfeeding, and both had broken down the barrier of curtains that shields them from each other, and were actually talking (which is so rare! Often in semi-private rooms, the two women never seem to have contact with each other; they keep the curtains shut the entire time, and politely ignore each other.) There was such a lovely energy in that room. Both women were so excited about their babies, and about breastfeeding. I must admit—this quickly became my favorite room.

One of the women in this room had had absolutely no problem breastfeeding her baby during my first night of work: both of them were learning so well, the baby was latching beautifully, and I got to spend a lot of time with them, teaching the mother how to latch and unlatch her baby, teaching her that yes, her baby really can breathe okay, even when her face is pressed all the way against the breast, teaching her how to prevent sore nipples, and how to recognize that her baby is getting enough, and how and when to start switching breasts, and what to expect once her milk comes in, and the safety-pin trick, and all of the gazillion things I love to teach and explain about breastfeeding. And they were doing great! The mother was loving it, and the baby was looking incredibly content, and I thought all was well.

Then, when I returned the following night to take care of them again, I learned that the baby had slept all day long, and hadn’t eaten at all for the past 15 hours (even though she had had several wet diapers, which is always a good sign). I reassured the mother that the first few days of life are sort of erratic in terms of sleeping and eating, and that eventually she and her daughter would fall into a routine, but as the night dragged on, the baby became fussier and fussier, and we were unable to get her to latch despite our best efforts, and despite the baby’s apparent hunger. Every time we put the baby to the breast, she would become absolutely hysterical, and then it would take several rounds of rocking and patting and sometimes walking with her to calm her down enough to try again. I couldn’t figure out what had happened! The night before, they could have been the poster couple for La Leche League, and then, one night later, it was a completely different story. The baby was hungry, and latching well enough, but every time she latched, she would just hang on the breast, refusing to suck, or else suck once or twice, and then grow hysterical again. I kept reassuring the mother, who was rapidly losing her confidence and her sanity, and we kept trying. I would leave the room to take care of my other patients, and come back to find the mother still awake and the baby still screaming.

Finally, finally, around 5:00 am, at our wits end, I suggested we try the side lying position, since we’d tried everything else and none of it had worked, and boom! I don’t know what it was about that position, especially when the other positions had been working just fine the night before, but all of a sudden, everything clicked again. The baby latched right away, calmed down immediately, nursed for at least 35 minutes, and then fell straight asleep. The mother got crampy from the nursing (which is also always a good sign that the latch is good, and that the baby is sucking well), I gave her some Motrin, and then she fell asleep too. They were absolutely adoreable sleeping together in the same bed after being up all night together. I pulled the curtains around them and shut the door and made sure that no one disturbed them.

And I know she’s not my baby, and this woman, prior to working with her for the past two nights, is a complete and total stranger to me, so you might say why do I even care so much? But I can’t even begin to tell you how happy and relieved I was that everything is going so well for this pair, and that the baby finally had such a good feeding, and that the mother didn’t end up losing her faith in herself, and in her body’s ability to feed her baby. The immense sense of satisfaction I felt as I left work this morning was indescribeable. It’s so nice to have such lovely patients, and to do work that you believe in so passionately (such as helping women breastfeed). I’m so lucky to love my job (well, love certain aspects of it, anyway), and to be able to feel like I’m making such a difference in people’s lives. Yes, I am on a breastfeeding high. Today, life is good.

OMG, check these out!! Wonderous Vulva Puppets! How absolutely, amazingly gorgeous! We wantssss one, precioussssss, yes, we do. The artist, Dorrie Lane, has named every puppet after a sacred feminine Goddess—she even has a puppet named after Hathor, the Egyptian Goddess of Love and joy (and fertility, and birth), and one of my own personal favorite Goddesses (along with Artemis, of course). What an amazing graduation gift for all the student midwives in your life. *cough*

Check out this article on the front page of today’s New York Times, discussing the rising incidence of gestational diabetes in New York, and what a worrisome trend this is. And then check out the fact that CNMs are quoted:

“It’s really disturbing to us that women come into their pregnancies obese and then leave them even more obese,” said Barbara Hackley, a certified nurse-midwife at the health center of the Children’s Health Fund and Montefiore Medical Center in the South Bronx. “I’ve seen weight gains during pregnancies of 50 to 60 pounds. We’ve had 11- and 12-pound babies that are very dangerous to deliver.”

Increasing rates of gestational diabetes…not so cool. Midwives quoted as experts in newspaper articles…very, very cool.