Belly Tales » Labor Support

Experience and Personal Practice

The Midwife — Tue, 06 Dec 2011 19:26:16 +0000

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?

Empowering Birth in the Trenches

The Midwife — Mon, 05 Sep 2011 12:49:55 +0000

Welcome to the Empowered Birth Week Blog Carnival
This post is part of the Empowered Birth Week Blog Carnival hosted by Child of the Nature Isle and Betsy Dewey. For this special event the carnival participants have shared their perspective on Empowered Birth. Please read to the end to find a list of links to the other carnival participants.

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When we think about empowered birth, we most often think about women going outside the system and choosing homebirths or unassisted births. We think about women who experienced a traumatic birth with a prior pregnancy and are now determined to do it differently. We think of finding the power and strength necessary to avoid interventions in our high-tech low-touch hospitals. We think of choosing to birth free of drugs and medications, and welcoming our babies into this world in the softest and safest ways possible. And certainly, all of this IS empowering, especially since it flies in the face of a birthing industry which has forgotten how to trust both women and birth. However, when we broaden our definition of empowerment, we can suddenly see that strength and joy and beauty can still be found in even in the trenches of the hospital system, and that empowerment can mean very different things to different people.

Cases in point: as a midwife working in an urban hospital with an under-served, medicaid-only population (some of New York City’s most vulnerable women), empowered birth doesn’t come in the usual trappings. By and large, we’re not dealing with women who’ve been doing their research and know exactly the kind of birth experience they’re looking for. The method of delivery, the type of interventions used or not used, the provider attending their birth, the setting, the soul-changing journey that birth can be is often of little importance compared to the much more immediate problems many of these women face: not enough food on the table, abusive partners, unstable housing situations, older children who are uncontrollable, substance abuse, peer pressure, high school (we all know how difficult high school can be!), minimum wage jobs which often involve intense physical labor or oppressive conditions, illegal status…the list goes on and on. As a midwife working in this hospital, birth plans are not something I’m seeing a lot of (although I have seen one or two!).

And of course, this is a hospital, bound by all of the usual, myriad hospital rules and regulations, some official, well-researched and evidence-based, others unofficial and absolutely asinine. There are 18 midwives in our practice at this hospital, but we’re employed not because the demand for midwifery care is so high, but because the hospital finds it more cost-effective to hire midwives instead of doctors (midwifery care saves money, after all). And while it’s a very good thing that our hospital doesn’t have a residency program, the sad truth is that we midwives basically function like residents; we do the majority of the triage, the majority of the admissions, and we’re the ones managing the floor, more or less (in collaboration with our attending physicians, of course, although many of our attending physicians are more than happy to wait in the wings and let us do the bulk of the work, which has its advantages and disadvantages). I’ve written about this type of hospital midwifery many times before in the past, and it certainly does present its own unique set of challenges and compromises. Nevertheless, empowered birth CAN and DOES happen in this setting, all the time; this is what it looks like:

Empowered birth is the woman who decides she doesn’t want an epidural. Sometimes she had decided this in advance, but very often this happens in the spur of the moment, as the woman is listening to her body and riding the labor wave. Sometimes this is decided in the face of (sometimes extreme) family pressure. I have attended births where the father of the baby or the patient’s mother or some other family member will seek me out repeatedly to tell me that the patient wants an epidural. This is most often well-intentioned, since the family member doesn’t want to see the woman in pain, but when I go into the room and actually talk to the woman about it, I hear a different story. She’s working hard, but she’s not ready for the epidural yet. Or, are there any other options besides the epidural? (In which case, we talk about other analgesics, like stadol, or position change–getting into the rocking chair, for example, and off of her back). I have been accused by family members many times before of being unfeeling, cruel, selfish, uncaring, but I’m always quick to point out that they’re not the ones in pain, and it’s not their decision to make. Of course, I’ve also seen this in reverse: a family who’s dead-set on a woman having a natural birth, but a woman deciding that she’s had enough, and would, in fact, like an epidural. And again, the same rules apply. If she’s not coping well with the pain, if she feels like she’s at her limit (whatever that limit might be) and would like some relief, she’s welcome to it, even if her family is telling her that she doesn’t need it. Empowered birth is helping a woman to have what she feels is the best pain coping method for HER birth, and helping to protect her decision, even when no one else in the room agrees with her choices.

Empowered birth is a woman deciding that she would like to have a VBAC, and finding a way achieve this goal come hell or high water. I like to think that our hospital has a pretty successful VBAC rate, and all of our attendings are very supportive of VBAC (though not always the most patient with a VBAC-ing woman, when push comes to shove), but one of the biggest challenges we face is the fact that our hospital requires a copy of the operative report from the woman’s prior cesarean in order to ensure that her uterine scar is low-transverse (i.e. horizontal), as opposed to a classical (vertical) incision, which has a much higher rate of uterine rupture. Many of these primary cesareans were done in foreign countries: Honduras, Haiti, the Dominican Republic, Mexico, Poland, Bangladesh, Egypt etc. etc. Getting a copy of an op report is a laborious process which often takes several months to obtain. First the woman has to contact her existing family members in her country of origin, who then have to trek out to the local hospital and go through the medical archives to find the report (if it can even be found!), and then send it to either the woman, or to our hospital. This requires a great deal of time and explanation during prenatal care devoted solely to finding of the op report. I have had patients go through this finding and obtaining process again and again. One patient brought me a copy of a report (all in Spanish) which detailed her stay at the hospital after her cesarean but said absolutely nothing about her actual uterine scar. After translating the report and going through it with her, I told her that she’d have to ask her family to go back to the hospital again and find the actual notes from her surgery, as written by the doctor who had performed it. Which she did, bringing in the correct report just days before she actually went into labor. Empowered birth is when this woman is so determined to have a VBAC that she’s more than willing to jump through all of these unfortunate hoops, and then empowered birth is watching her successfully deliver her baby vaginally just a few days later.

Empowered birth is watching a fifteen year old (wo)man up to the task at hand and finally do what has to be done to birth her child. Sometimes this comes only after hours and hours of watching her run from the pain, or refuse to push, or throw the equivalent of an adolescent temper-tantrum; sometimes it’s impossible for her to think about anyone or anything else besides herself for most of the labor. And yet, inevitably, there comes a point in the labor when she realizes that she is the only one who can get herself out of her current predicament, that there’s no other way out except to actually hunker down and do the work. Empowered birth happens when she finally realizes she’s the one who has to rise to the occasion, and then watching her do exactly that. And sometimes it comes as a complete surprise—adolescents you’ve cared for during their pregnancies who have been needy, high-maintenance, low-pain-tolerance drama queens can sometimes turn around and completely bowl you over by their grace, maturity and strength during birth. Empowered birth is learning (again and again and yet again) to NEVER underestimate an adolescent, just because she is young, and to always trust her.

Empowered birth happens in our hospital when, after a long, two-day induction for oligohydramnios, a woman decides she’s finally had ENOUGH of the wise-cracks and mean comments and general lack of support from her partner, and insists that he leave the room. Empowered birth is that woman claiming her right in that moment to be surrounded only by people who are helpful and supportive of her. And as the midwife in this situation, this sometimes means calling hospital police to make sure that the unwanted party isn’t allowed back in, or providing hospital police with a copy of a patient’s order of protection to make sure that unwanted “guests” can’t just drop in unexpectedly. Empowered birth happens every time a woman demands nothing but respect and support during her birth.

Empowered birth happens in operating rooms during necessary cesareans when a woman is 100% present while giving birth. It happens when her face lights up at the very first sound of her baby’s cry. It happens when she insists on having her baby close to her immediately, with either the partner or family member or midwife holding her baby up to her face so that they can look each other in the eye for the very first time, despite the disapproving look and pursed lips of the anesthesiologist. Empowered birth even happens afterwards, when she breastfeeds that baby shortly thereafter in the recovery room.

I believe that the act of giving birth is in itself empowering, and that birth is capable of transforming a woman even if there wasn’t a lot of forethought or planning put into the where, why and how of it. When we widen our gaze and look at all the ways that women can be empowered even in situations which don’t, on their surface, look like they are, we see that empowered birth comes in all shapes and sizes, just like women do! Empowered birth happens whenever a woman decides: this is my experience, my birth, my baby, MINE, and I claim it.

The Empowered Birth Blog Carnival was lovingly hosted by Child of the Nature Isle and Betsy Dewey

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We invite you to sit, relax and take time to read the excellent and empowering posts by the other carnival participants:

Empowered Birthing – Amy at Anktangle shares a simple list of things that support an empowered birth experience.

Little Miss Green’s Home, Water Birth Story – Mrs Green at Little Green Blog shares her (home, water) birth story. Even though it happened 10 years ago, the empowering feelings are the same to this day (and yep, it STILL makes her cry!). This post is also a tribute to her husband who was there mind, body and soul throughout.

Save Birth, Change The World – Toni Harman, mum and film-maker talks about the highs and lows of creating the ONE WORLD BIRTH film project dedicated to helping more women around the world have empowered births.

12 Steps to an Empowered Natural Birth – Terri at Child of the Nature Isle wants to talk to all pregnant women and tell them YES they can have an Empowered Birth! This is her personal 12 step guide.

The Blessingway: a sacred blessing for birth – The Blessingway is a sacred ceremonial circle of women gathered with the intention of blessing and preparing a pregnant woman and her child to give birth. Betsy Dewey describes the beauty and the how-to of a modern Blessingway.

Informed Birth is Empowered Birth – Darcel at The Mahogany Way Birth Cafe tells us why it’s important to take control and be responsible for our own births. She says Informed Birth is Empowered Birth.

An Empowered First Birth – Zoie at TouchstoneZ follows the path she took to her first homebirth and finds she may not have started out as the best candidate for an empowered birth.

And this one to be published on Sept 12th :
Empowered Birth: From the Personal to the Universal – Zoie at TouchstoneZ questions the criteria for what makes an empowered birth and finds she has to let them all go.

One World Birth about to launch!

The Midwife — Tue, 30 Aug 2011 17:29:32 +0000

Just stumbled upon this via a friend on Facebook, and watching the welcome video just sent chills down my spine. Two passionate filmmakers are creating an interactive, continuously-updated online TV channel focusing on nothing but birth, and the state of birth in our world right now, by interviewing the world’s leading experts in birth and attempting to fuse birth, birth education and film-making. Their mission is to empower women to believe that they CAN give birth, fully informed of their choices. Now that’s a mission I can get behind! Oneworldbirth.net will launch on September 1st; until then, you can watch the website trailer below:

This video was embedded using the YouTuber plugin by Roy Tanck. Adobe Flash Player is required to view the video.

My one hope is that they don’t just focus on birth in the developed world (although, granted, we’re desperately in need of a birth revolution here in the developed world), but also tackle some of the ongoing issues in the developing world, too. I can’t wait to see what comes next out of this! Viva la revolucion!

50th Birth

The Midwife — Sat, 10 Nov 2007 05:04:48 +0000

Today I caught my 50th baby! She was born at 4:18 pm to a young woman from Puerto Rico who was absolutely thrilled and excited about her first pregnancy. She was an induction for postdates (per hospital policy, all women are induced if they’re still pregnant at 41 weeks); she’d actually had an incidence of preterm labor earlier in her pregnancy, but now, instead of the baby coming too soon, we had the opposite problem—a baby that didn’t want to leave. Because she was an induction, she was on pitocin, and because she was on pitocin, she pretty much had to stay in bed (again with the hospital protocols…). She was so strong and so tough, though, laboring in bed for the entire afternoon and refusing an epidural the entire time, through every single pitocin-induced, booming, more-intense-than-natural-labor contraction. The only thing she took for pain was a dose of stadol when she was around 5 cm dilated. I think her birth team made a big difference for her. Her mother and the father of the baby were at the bedside with her all afternoon, fanning her and bringing juice and ice water, putting cold packs on her head when she was hot, massaging her legs and arms. I couldn’t get over the father, in particular. He was such a young man (19 years old!), but his maturity was well beyond his years. He knew just when to be attentive, and just when to be quiet and not pester her with questions or ministrations or conversation (during transition, she didn’t want anyone to touch her). When she was pushing, he was so excited by the tiny glimpses of head we were seeing with each push; he couldn’t wait to meet his baby. He kept encouraging her to keep pushing, she could do it, soon she’d have their baby etc. etc. (I barely had to say a word of encouragement, he was doing such a good job of it all on his own). We pulled the mirror out after the first hour of pushing, and this really made a difference for her. Once she could see her progress in the mirror each push was better and better. The baby crowned in right occiput anterior, and she was able to breathe the baby out in between the contractions in such a way that she didn’t even tear her perineum (she did have a small laceration inside the vagina which required 5 stitches, but the actual perineum itself was intact). When the head restituted, the shoulders came out almost transverse rather than vertically. It was almost as if the baby were spinning inside her very roomy pelvis. The little girl (7 lbs, 2 oz.) started crying almost right away, and her beautiful family all burst into tears (especially the young father), which then made me tear up as well (seeing a family cry always gets to me, every time). The father cut the cord. Afterwards, the baby latched onto the breast like a pro and had a very tasty meal of colustrum while I did the small repair. There was no other midwife in the room with me (my preceptor was out at the nurse’s station, within shouting range, but minding her own business). The saying goes that somewhere around 100 babies, you start to get a clue as a new midwife. I guess that means that I have roughly half a clue, right now, but today, for the first time, I felt like…yes, I really am I midwife.

Closer to the dream

The Midwife — Thu, 30 Nov 2006 18:09:21 +0000

Last week I had an exam in Neonatology, and my teaching project and a presentation in Neonatology all due at the same time, so it was a bit hectic. This week, the only thing on my plate is a few modules and some studying for the upcoming final exams, and a write-up of my teaching presentation, so I’m taking a justified, (albeit brief) break, and blogging for a delicious change.

I was looking back over some of the posts I’d written about hospital birth over the past year and a half, and I feel that the time has come to eat some crow. Not a huge amount of crow—not a grilled crow steak with onions and salad and the works, but maybe a crow kebab or crow pie appetizer. I think I was feeling very burned out this past summer, very very tired of all of the hospital birth BS, and I think a lot of that had to do with how very tired I was of working as a nurse. I was (and am) ready for change, and ready to be working as a midwife, and now that I’m actually more than halfway through my IP clinical rotation, and am finally (FINALLY!!!) catching babies, it’s as if a large piece of the puzzle has fallen into place. Suddenly, everything feels right in the universe, and I’ve been so ridiculously happy lately, now that I am actually doing what I have wanted to do for so long—this glorious, miraculous, beautiful work that has called to me for over 5 years now. So, the burned out feeling is gone, and in it’s place is a refreshing sense of growth, because I am learning so much right now, and heading in such a fantastic direction, and things finally feel like they’re moving. It’s slowly dawning on me that school will in fact be over (probably much sooner than I’m ready for), and that I will indeed be a midwife someday (really, truly!!).

The point being, the hospital where I’m currently doing my clinical rotation flips a lot of the hospital-birth stereotypes on their heads, and maybe this has a lot to do with the fact that midwives are employed by this hospital, and respected by this hospital (and the OB Dept., which says a lot right there), and do a lot of the work of running the labor and delivery floor. I can only write from my experience, and this is what I’ve seen: 3 years of working as an L&D nurse in two seperate hospitals, and I’d say that at least 90% – 95% of all births involved an epidural. A woman without an epidural was either making a huge and difficult point to labor “naturally”, or had simply managed to show up to the hospital fully dilated and unable to recieve one in time before she delivered. I can’t say that the majority of births I’ve seen have had at least a 1st degree laceration, but I do feel that at work, an intact perineum is often a rarity, and a very pleasant surprise. Women, as a rule, are not allowed to eat or drink during labor. The squat bar often sat gathering dust in a corner, the birthing balls were rarely (if ever) used, and getting a woman out of bed was always a very rare and unexpected treat, that often required a lot of fighting for. It was never the norm.

And this is not to say that there are no fights to be fought at the hospital where I am currently doing my clinicals, but I’ve been paging through my delivery book (21 births so far, believe it or not!!!) and noticing that more than halfof the woman I’ve worked with haven’t had any analgesia or anesthesia on board (14 out of 21, to be exact). The majority of them have had intact perineums. I’ve used the squat bar more times in the past 7 weeks than I have used it or seen it used in the past year at the hospital where I’m working. The women on the floor are almost always given clears to drink, which is a much better deal than being NPO (i.e., not allowed to eat or drink anything), and some women are even allowed to eat some lunch in the early part of their labor or induction. And while getting a woman out of bed still causes a lot of eyebrows to be raised, I’ve seen it happen at least 4 times so far, and once we even got the woman out of bed, off the monitor, and into the shower, where she would have remained if only someone could have stayed in the room with her to fend off the anxious nurses trying to get her back on the monitor.

Oh, and VBACs! Did I mention that this hospital does VBACs? And not just attempted VBACS, but actual, squalling-baby-born-vaginally type VBACs?? Very very pleasant surprise. I think I can possibly count on one hand the number of successful VBACs I’ve seen at Tried and True Hospital.

And have I mentioned lately how much I’m enjoying my clinical rotation so far? And these births!! All these beautiful births!! I’ve caught so many babies so far! I feel so blessed, and so lucky, despite the exhaustion and over-worked brain and tired legs and mounds of homework. I stayed late one night and caught three babies in a row, one right after the other—women I’d been laboring with all day, and had been examining all day, and watching as their cervixes changed from 2 cm to 6 cm to fully dilated, and was then lucky enough to be able to catch all of their babies. Afterwards, at around 2:00 in the morning, as I was finally leaving, I stopped by the postpartum room of the first woman I had delivered that night (she was a successful VBAC!!) to say goodbye. She had been wearing a gorgeous woven cloth rosary around her neck throughout her entire pregnancy and birth, and she pulled it off and gave it to me, and I walked down to the lobby with tears in my eyes, cradling the beautiful rosary. It is such an honor, and such a gift, to be able to be with women at the moment of their births, and to be able to catch their babies. Some days I can’t believe my luck and good fortune, because that’s really what it feels like to me. I am such a lucky woman! This really is the best job in the world.

A few more NYC resources

The Midwife — Tue, 02 Aug 2005 00:44:05 +0000

Just a quick heads-up to let you know that BirthFocus.com and The Metropolitan Doula Group have been added as links under the following headings: Midwifery–> NY State Midwifery Links, Education–>Birth Education and Labor and Birth–>Birth Support.

BirthFocus, like Realbirth, offers several different childbirth preparation classes for pregnant women in NYC, as well as referrals for doulas and continuing education classes for birth professionals. The Metropolitan Doula Group is an umbrella group for NYC-based doulas, offering a supportive and educational forum for doulas and other birth professionals through monthly meetings and online discussion boards. Both of these are fantastic resources, especially if you live in NYC. Check them out!

Emotional Support during labor CAN’T be overlooked

The Midwife — Thu, 28 Apr 2005 13:53:02 +0000

Full citation: Kennell, J., Klaus, M., McGrath, S., Robertson, S., & Hinkley, C. (1991). Continuous Emotional Support During Labor in a US Hospital. JAMA, 265(17), 2197-2201.

Attention all doulas out there: this is something you really need to read. It’s one of my favorite studies of all time, actually. I discovered it in Nursing School when I was writing a report on health care policy measures which could be used to lower our abysmally high c-section rate. This study found that the importance of continuous emotional support during labor cannot be overemphasized, which isn’t really news to a midwife or doula, but is something that many doctors tend to overlook, not to mention many of our hospitals, and the field of obstetrics in general. We have whole systems devoted to the get ‘em in, get ‘em delivered, get ‘em out approach, with a lot of time and attention spent on interventions which allegedly speed up birth, such as inductions and the judicious use of pitocin, and of course, there’s the misguided idea that a cesarean is actually a safer, faster, healthier option than a vaginal birth (as our growing elective primary c-section rate would attest). What this study found was that continuous emotional support during labor not only lowered the c-section rate, but also shortened the length of labor, and even lowered the epidural rate. Pretty powerful stuff!

In this remarkable study performed at Jefferson Davis Hospital in Houston, TX, researchers paired women in labor with either a doula or a non-interactive observer, and compared the cesarean section (CS) rates of both groups to a control group which received no outside support other than the hospital staff. The doulas had all experienced a normal labor and vaginal delivery, were fluent in English and Spanish, had been trained in labor support techniques during a three week intensive, and were comfortable dealing with both patients and medical staff. During labor, the doulas offered continuous hands-on support, often holding, massaging and verbally reassuring the woman in labor, as well as explaining what was happening during labor and what would likely happen next. In contrast, the non-interactive observer, while also continuously present, maintained an inconspicuous role and never spoke with the patient. The results of this study revealed that doulas had a profound effect on the CS rate: women with doula support had an 8% CS rate as compared to a 13% CS rate for the observed group and an 18% CS rate for the control group. Doula supported women also had a lower rate of epidural use (7.8% vs. 22.6% and 55.3% for the observer and control groups, respectively) a shorter labor (an average of 7.4 hours v. 8.4 and 9.4 hours for the observer and control groups) and a reduced rate of oxytocin use, maternal fever and prolonged infant hospitalization. Although they were unable to draw any conclusive reasons for these striking differences, the researchers did conjecture that reduced maternal anxiety in the doula-supported group could have been responsible. The authors also indicated that the support given by doulas was different from the support given by male partners, and that the doulas tended to provide more physical reassurance than the male partners, perhaps because they were more familiar and comfortable with the labor process.

There you have it. The benefits of this study are self-evident: even simply having someone in the room on a continual basis proved effective in lowering the CS rate (even if they weren’t saying a word). Midwife means “with woman”, and to my way of thinking, any decent midwife worth his or her salt rarely leaves his or her patient’s side. Similarly, this might help explain why midwives, using the Midwifery Model of Care, which emphasizes a hands-on approach, have a much lower c-section rate, a lower epidural rate, and shorter, less-complicated labors in general. Or why having a doula is the next best thing, if you don’t have a midwife. Or, have a midwife *and* a doula, and amaze all your friends with the brevity and ease of your birth story! Well, that might be pushing it slightly, but you see the point. A trained labor companion, by reducing maternal anxiety, educating the patient and providing continuous support, can not only expedite delivery but also produce a better outcome. It’s really validating when you find a study that supports what you’ve known and believed all along.