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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The 9 metre long polyptych consists of four hundred plaster casts of vulvas, all of them unique, arranged into ten large panels. McCartney set out to make this project as broad and inclusive as possible. The age range of the women is from 18 to 76. Included are mothers and daughters, identical twins, transgendered men and women as well as a woman pre and post natal and another one pre and post labiaplasty.

It’s not vulgar, it’s vulva! This isn’t just sensation, it is art with a social conscience and McCartney wants people to stop, look and listen. This is about grabbing the attention, using humour and spectacle, and then educating people about what normal women really look like. Described as “the Vagina Monologues of sculpture” this piece is intended to change the lives of women, forever.

“For many women their genital appearance is a source of anxiety and I was in a unique position to do something about that.”

Vulvas and labia are as different as faces and many people, particularly women, don’t seem to know that. McCartney hopes this sculpture will help to combat the exponential rise, seen in recent years, of cosmetic labial surgeries. This new fashion for creating ‘perfect’ vaginas sets a worrying trend for future generations of women.

Wow.  Um, yeah, I agree.  Wow.

*  Remember the baby in all of this.  As midwives in particular we’re so focused on the woman–the mother, the mother, the mother–her experience, her birth, her power, her strength, her triumph, her fears, her labor, that we forget that there’s a second silent passenger traveling with her every step of the way.  Karen talked about treating pregnant women almost as if you’re treating siamese twins–it would be rude to talk to just one twin as if the other isn’t there, you have to talk to both, so in that sense, everything you explain to the mother you should also explain to the baby.  We need to treat them the way we would want to be treated; this includes telling the baby what you’re going to do before you do it, telling the baby what’s going on, telling the baby what you want her to do, and telling her the story of what’s happened.  And reminding the parents to do the same, so that the baby hears this from everyone, not just from the midwife or doula.

*  Think long and hard about what birth might feel like from the baby’s perspective; how emerging into the super-bright, super-loud, super-chaotic world can be incredibly overwhelming and traumatic, even in the calmest and gentlest of births, and that in births where the baby requires resuscitation and intervention, even more so.  And think about the baby’s story in all of this.  Their early cries may be their attempt to be heard, to tell their story to the world, and to know that they’re not alone, that someone is listening.  Being present at the birth means being able to slow down and listen to what your baby is saying.  As the mother, you are the emotional regulator of your child.  If your baby is crying, notice how that makes you feel inside (frantic, frightened, worried?)–your baby may be responding to your emotions, since everything they know/ feel is a mirror of what you know/ feel.  Then take a moment to calm and collect yourself–how do you feel now?  By telling the story and naming what is happening or happened, you are helping the baby integrate their story (experience). For example, tell the baby that they’ve been born–they might not realize it yet.  Yes, that was really scary, and really hard, and really long, but we hear you, and you’re out now, you’re safe now. And calm yourself down while you’re saying it; then watch your baby mirror your emotions.

*  Everything that happens to the mother during pregnancy is also happening to the baby.  Motherbaby is  completely undifferentiated, and because of this the baby feels the impact of every stressful moment the mother experiences, even if it’s just for a second (such as slamming on the brakes while driving because another car cut in front, only to realize a moment later that you’re fine), except that the baby continues to feel the stress and adrenaline of the moment without the knowledge or understanding that it was temporary and not really a big deal.  The only way to counter the release of adrenaline is with the release of oxytocin, the feel-good love hormone that calms and soothes and relaxes again.  So as in the point above, it’s crucial to teach pregnant women to take a moment when they’re feeling stressed to ground themselves, feel where their feet connect to the floor, breathe, and release oxytocin in the process.  The time in utero, more than any other time in the baby’s life, is what’s developing and deciding who they are; babies are forming (marinating) in their mothers’ emotional states, this is what’s setting up their personalities, beliefs, termperments etc..  Stress is ok (and unavoidable), but the baby needs breaks from the stress, moments when the oxytocin flows again and s/he can relax again; teach moms to release the adrenaline, acknowledge what happened, tell the baby everything is ok, and then get a hug or a massage or some ice cream (great for relieving oxytocin).  Interested in learning more about this? Check out Prenatal Parenting by Dr. Frederick Wirth.

*  Oxygen is TOXIC.  It causes free radical damage, especially at high amounts, and especially with preterm infants. The newest guidelines from the AAP recommend starting a resuscitation on room air and then titrating up from 21% O2 (room air) until the correct O2 sats have been achieved in the infant.  And remember that it takes up to 10 minutes for a baby to be satting at the correct level–this is all part of the normal newborn transition.  There is a new chart in the 6th Edition NRP book with suggested O2 levels for the first 10 minutes of life, based on 100% O2.  The idea is that table is there to help guide the use of 100% O2, but if you don’t have an O2 Sat, then you shouldn’t be using 100% O2. Use room air (and keep in mind, if you’re giving mouth to mouth resuscitation instead of bag/mask, you’re delivering approx. 16% O2).

*  Babies need their full blood volume.  It belongs to them.  Only public demand will change the length of time practitioners wait before clamping the cord.  The research is already there (has already been there for years) about the benefits of delayed cord clamping, and STILL practitioners will commonly clamp and cut the cord immediately after birth, despite the research.  Now the only thing left to do is to educate the public so that they will start to DEMAND delayed cord clamping.  If you need more proof, look up Dr. Nicholas Fogelson on You Tube and watch his grand round presentations on this.  If you need to resuscitate, keep the baby attached to the cord, keep the baby lower than the placenta so the blood can drain into the baby, and milk the cord or have the mom give a few small pushes to get even more blood into the baby.  None of the concerns about polycythemia/ increased bilirubin/ jaundice with delayed cord clamping has been confirmed by research.

*  In the UK textbooks for neonatal resuscitation, there is a differentiation between inflation breaths versus ventilation breaths.  The first few breaths given to a newborn during resuscitation are inflation breaths. The purpose of these breaths is to expand the lungs and clear out the fluid which is there before birth.  These breaths need to be a little bit longer with a little bit more pressure.  In the AAP 6th Edition, no distinction is made between inflation breaths versus ventilation breaths, although they do concede that a little bit more pressure may be needed at the beginning to help clear the lungs of fluid.

*  The GOLDEN HOUR after birth is the most important time for bonding, and as a care provider we must do everything we can to help preserve this time.  The baby and mother have both been primed for the bonding through hormonal changes, and the blue print is there for this to occur, but the first hour after birth is when the gears actually align and the bonding is actually cemented.  This is the moment when the baby learns that after the stress of birth, there is a place of safety, rest and relaxation waiting for her/him.   This time is PRECIOUS, and you will never have this hour again.  Teach your parents birth etiquette. The Golden Hour is not the time to be sending photos or texting or emailing or being pulled away from your baby–it’s the time to be totally plugged in and PRESENT.  If for some reason the baby needed resuscitation or was separated from his mom, the Golden Hour happens whenever it is that mom and baby are reunited for the first time.

And that is just the smallest glimpse into everything I learned…not to mention how to correctly do mouth-t0-mouth resuscitation in a home setting.  Seriously, if Karen Strange comes to your city and you have a chance to take a class with her…run, don’t walk!

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Fall of 2011 had just began and I noticed I had missed my period, not one but two months. This was rather odd as I was doing well health wise, loosing weight and my Thyroid medication I had been on for the past year or so was working well. Since being on the medicine, my periods had become close to regular every month, something which I hadn’t experienced since before our first daughter was born back in 2004.  July we had dropped our health insurance because we could no longer afford to pay half the premium anymore as it had gone up 5-6 times in the past couple years. So after making sure our daughter, Maddy, had health insurance from the state we went with out insurance for ourselves, not knowing we would be blessed to learn were expecting another baby girl!  There was a new pregnancy resource center in town that offered free tests, so I made the decision to go, even though I had my doubts. I tested and got a very faint line, which turned out to be because I was a little early in testing. In the coming weeks I would make an appointment with the OBGYN I had been seeing for my thyroid. A blood test as well as an ultrasound was done and I was just in pure amazement. For years and years we had waited and were not sure if we would ever be blessed with another baby again due to my Thyroid troubles. But in the last couple years I had a peace within myself in whatever happened. When I found out I was expecting a baby I went home and just smiled from ear to ear, I couldn’t believe I was given a chance to be a mommy again!

Fast forward to the Spring of 2011… I went into preterm labor at 34 weeks and went into the hospital to be monitored and then had my labor stopped. We were also in the process of getting ready to move in the next couple months. The plan was to be at our new place by July 1st, but we had most of the house already packed. We had everything we needed ready to go for the baby’s arrival, but one thing I learned through this experience is I will never plan a move while having a baby again.  Time is precious and babies are only babies for a short while. It was a necessary move in that it would affect all of our lives for the better.  Sure enough, moving has been a major blessing in our lives and one less stress to have an employer that values my husband and his abilities.

To get back to the actual birth story… It was Tuesday morning May 3rd and I had a liner on because my bladder was unpredictable; we all know how it is at this point in pregnancy. I was standing in the kitchen making Maddy a Peanut Butter and Jelly sandwich for her lunch that day at school and I noticed my liner was soaked, like I peed my pants.  So after I finished went to the bathroom and got a fresh pair of underwear and then put on another liner and stood there, and within a few minutes it was soaked as well. So this time I stood in the shower and just stood there with nothing on and tiny little gushes trickled down my legs. It was so tiny I couldn’t tell if it was my bladder or what, but knew it was odd. I had my water broken manually to start labor with Maddy and it was a humungous gush, so that is another reason why I was so puzzled, because this was not like that.  (I will never allow anyone to manually break my water again to induce labor.  Being a first time mom I didn’t know any better at the time.)  So anyways, we got Maddy off to school, I took a shower and got my bag and stuff in the car and off to L&D we went, because we were advised to go and get things checked out. I went into the bathroom and the nurse had a litmus strip to test if it was amniotic fluid or not.  It turned bright blue immediately which was positive. I had tested positive for Group Beta Strep at my check up the week before (I didn’t when I was pregnant with Maddy so that was new), so now because I was GBS positive I could not go home during early labor and I had to be admitted and started on my rounds of antibiotics right away. I almost wonder if infection caused my water to break or if it’s just that Grace wanted to come early; this was the question I originally asked myself after giving birth. Over the course of the next year I would find it out all the signs lead to me having an infection due to both GBS and a tooth infection I was unaware of at the time.

Once we were admitted we had called Maddy’s teacher who graciously offered Maddy a place to stay while we had the baby in the hospital. All of our family and friends lived out of state, and my mom and sister were not going to be able to visit for a couple months. So we were forever grateful for the graciousness of those we knew in our community.  Maddy had her own bag ready to go as well for when the time came for her to stay the night.  Grace was doing fine on the monitors so I was happy about that.  I had a really great nurse during the day who used to be a doula, which was very comforting. As a matter of fact this time I had an official doula, too.  It was my first experience having one and I thought it was totally worth it.  Our Doula Shellie was also Maddy’s occupational therapist so we were friends, and it was great. We waited to call her in with us until my contractions were a bit closer together and more regular. I didn’t go into contractions right away either.  After getting my first round of antibiotics and monitored for a bit, I had my IV hep-locked, (this makes it more portable, since the tubing can be hooked in and out of it) and I was un-tethered from the IV so I could walk.  I walked and walked for a few hours.  I noticed crampy-type pains coming and then after a while I was having regular contractions, but they were very tolerable, even though they were becoming more noticeable. I forgot to mention I was having contractions when I first came in and never realized it; you could see them on the monitor in the beginning and I was not feeling them, which again is something I never experienced that with Maddy so it was really weird!  I was on a time schedule for my antibiotics so they would give me a time to watch for to start another round of antibiotics again and in the mean time I was free to do whatever I wanted. I noticed that if I stayed in bed my labor would kind of slow down. So I made sure I was up and walking as much as I could and they fed me lunch! I was so surprised! This didn’t happen with Maddy, I wasn’t allowed anything! I loved sitting on the birth ball they provided me with, that helped cushion the spikes of the contractions and bouncing on it helped keep them going.

So as things picked up sometime late afternoon.  Early evening we called in our doula, Shellie.  Right before we called her in I had a small stall as well, and she had suggested over the phone that we maybe try a prostaglandin pill, I forget what it’s called [Editor's note: this was probably either cytotec or cervadil] which usually the put in your cervix to soften and get things started [Editor's note: it goes into the vagina underneath the cervix and is used as a cervical ripener]. I was very apprehensive about it, but needed to find a way to get things going again. It seemed to do the trick for and for while and I was contracting again. Our doula arrived and she was great and had a bag of all kinds of things she could use during labor to help.

My labor again stalled though not long after she had came, because I had to sit in bed for my round of antibiotics and the contractions subsided a bit. They were still there but not consistent. We talked to the Doctor and he said it was up to me, he was still very respectful of my birth plan but guided me through my decisions  and didn’t make them for me.  I was not used to this and this helped me be much more comfortable in having a hospital birth, as my last hospital birth was much more about telling me what to do and unnecessary interventions, such as manually breaking my water and early induction. This time around, however, it was a wonderful experience.  I told him I wanted to get up and walk and try a little while longer and see what happens over the next few hours and he agreed. So my doula began walking the hallways with us and talking and joking with my husband, keeping things a great atmosphere.  Sure enough walking did the trick again and I got back into a rhythm. I was able to smile and laugh and talk in between contractions, it was so different than my first labor. I think because my body was able to develop it’s own rhythm rather than being forced into one by induction, where I had my water broken and my body was kind of slammed into labor it literally felt like I was being wrung out like a sponge with searing pain. This time allowing it to come naturally it was much more tolerable. I was amazed, because when talking with my doula before birth at our formal meeting, I told her I was nervous but wanted to find a way to have a natural birth and find a way to work with my body. She gave me some tips for breathing; something I wasn’t taught in my Lamaze classes during my first pregnancy was how to actually fill up your lungs with air not just shallow breathing, and that did wonders! Basically they were hypno-birthing techniques that helped me find a relaxed state with as well as finding ways to not allow tension in your body. If she would see a section of my body tense up, like my shoulders tense up or another part of my body she would say “do a tension check” or let me know the specific part of my body that was tense and I could focus and make a point to relax each area of my body one section at a time and it worked! I can’t describe how, but it did.  She also described to me how the muscles work during labor in our formal meeting, which I didn’t know with Maddy; she also helped me learn how to visualize it and that also helped my body really get into a rhythm and really understand what I was doing.

So I was sailing away and time was just weird, the concept of time is so different in labor, sometimes it would fly other times it seemed like forever. My contractions were going strong and really spiked, they were lasting longer and a little more intense at the peak, but eventually the prostaglandin pill wore off and I needed to take a break from walking for a minute. So I had a slight stall again, but I did not loose faith, I was at complete peace with no pressure from my doctor and in control of my birth experience.

Meanwhile my doula ran me a bath in the Jacuzzi tub and put some lavender oil in there, oh my that was heaven! She then started an acupressure technique where she pressed on a pressure point near my ankle and then rubbed the side of my pinky toe, I am not kidding! And it worked!  Within no time I was contracting again! I was at 5 or 6cm at that time and within a few hours I had made it to 8cm. In the tub I was getting those spiky contractions again towards the end and would lay against the jets up against my back and it would help so much. I could smile and talk in between them and she was so positive to me and telling me what a wonderful job I was doing and how impressed she was with how in tune I was with my body. I felt like superwoman!  I could tell the contractions were getting more intense and she didn’t need to keep doing the acupressure anymore.  I got out and was checked and I was 8 cm. My nurse at night was awesome and my Shellie loved her and told me I got the best nurse on the entire floor that night. Shellie was right, she was my favorite nurse, so it just made my night. The nurse was so positive about my birth plan and showed me the wireless monitor so she didn’t have to drag me out of the tub to monitor the baby, but walked over to me and held it on my stomach instead.  I didn’t even know there was such a thing! She was telling me that some nurses don’t like them because it requires a little more patience and work, but they were awesome for natural labors like mine.

Shellie told me it shouldn’t be long now because my contractions were intense, and that I was entering transition. These contractions I really really had to concentrate on, they were very painful at their peaks but I thought of it like a roller coaster and that once I could reach that peak then it would cruise back down. Then I would get a break. They got intense but at the same time they weren’t one on top of another because I had maintained a rhythm.  With my first labor they were one on top of another, no rhythm at all and I felt as if I was working against my body. I didn’t know how find a rhythm or visualize and without a doula I had no one to ask for help. So having a doula by my side this time and knowing what was going on was so helpful.  This time I was ready and full of actual information in large part due to the consultation with Shellie before labor itself started. I honestly think had I not gotten an epidural with my first labor, I would have stalled and ended up with a C-Section because having an epidural was the only thing that allowed my body to calm down and dilate.

However, this time I wanted things to be different.  I wanted to know what it was like to experience labor; my goal was to make it through it on my own. As I entered transition I was leaning up against Jed.  I would lay my head in his shoulder, or squeeze his hand, but after a while it got to the point that even this wasn’t working anymore.  So I had him sit down and take a break.  I was checked and found out I was fully effaced and dilated to 10 cm with just a tiny lip of cervix, but the nurse fixed that.  I continued on through the strong contractions of transition and it was the hardest part but I knew the end was in sight and kept telling myself I am almost there; finding the strength within myself in my own mind was what got me through it. I was humming/moaning through the contractions and breathing, I can remember my doula explaining to my husband that my noises were pushing noises and it sounded like my body was getting close and she was exactly right.

The most amazing experience happened to me during transition, and Shellie had described this phenomenon to me in our meeting. I would have a very very hard and long contraction and I am not sure exactly how long but with the hypno-birthing technique I was able to relax myself so much that I actually went into a deep sleep in between each contraction. It was the most incredible feeling and each time I felt rested and ready for another. It was almost as if I was going into REM sleep. That is something I will never forget! Within around 30 minutes (I can’t remember exactly how long) it was finally time to push.  I suddenly felt pressure and then it literally felt like a ring of fire just like I have been told and then Grace crowned and within 3 or 4 pushes she was out. No tearing at all, I was amazed! She was 6lbs 12 ¼ ounces, a small little girl and a lot of white vernix. Thankfully she didn’t have any breathing problems and did well and I was able to hold her and got her to breastfeed, but she was a sleepy little girl and got a little cold so they gave me a couple more blankets out of the warmer and I pushed out the placenta very easily and the doctor said it looked great and very healthy.

I requested in my birth plan to let the cord keep pulsating and only cut it once it had stopped, and the doctor honored my wishes! This request can be very hard to get in a birth plan sometimes, but he was amazing.  So she got all her cord blood. I had no hemorrhaging at all, either.  I was nervous because with my first labor I did and I often wonder if it was because result of all the interventions sometimes.  What made me decide to have a hospital birth this time around was a desire to prevent bleeding complications similar to what I had with my first birth, but also having a supportive doctor, nurses and wonderful doula made it seem as if I were almost at home.  So after the placenta was out the nurse wheeled me into the nursery and Baby Grace was warmed up and then washed up. With Maddy I wasn’t even asked or allowed into the room for her first bath, this time they made sure I was everywhere I wanted to be with the baby. So I was really happy about that.

I had a wonderful lactation consultant and with her help Grace learned to suck.  Bcause she was born at 36 weeks just a few days before 37 weeks, Grace wasn’t good at sucking and needed a little help.  With a little practice she was taught to latch on beautifully; she was doing great and getting a lot of colustrum in fact so much that she over filled her belly a few times.  We were almost going to be released and then she starting exhibiting signs of jaundice and it got kind of bad, so we ended up staying a few more days in the hospital till May 8th and didn’t get released until the afternoon of Mother’s day. It was a hard few days, my husband had to go back home and get our daughter Maddy because she had become extremely homesick and told her teacher that she wanted to see mommy and sleep in her bed. She had fun out on her teacher’s farm, but missed home, and because of needing structure due to her Autism, Jed and I decided it would be best if he stayed with her and they would visit me every day and then I would stay with the baby. It was harder than I thought it would be, at first most of the nurses were ok, but the first had me keep Grace under the table in my room the entire day. Normally I would be just fine with rooming in, however I could not go to the bathroom, could not eat, and had no one there to help me, and the reason why is the stupid glasses they used kept falling off Grace’s eyes and I had to keep them on in order to not damage her eyes. The night before the nurse who was with me during my birth was working in the nursery, and that night she had put a baby hat that she had cut out to make a much more effective and softer band, with several layers to protect the eyes. It was much more comfortable for the babies than the goggles they had. But by day I had to monitor the baby in my room, and a different nurse put on the horrible goggles and said what the nurse I liked on the night shift had done was against the rules blah blah blah.  Grace kept pulling the goggles off; pretty much every few minutes I had to put them back on, so as I mentioned I was struggling to change my pads, go to the bathroom and eat and was a little frustrated at the nurse.  Thankfully night shifted started at 7pm and another nice nurse that I liked took over and it was a Godsend!  She allowed me to get sleep at night and took very good care of Grace for me when I needed a break.

I was a little stressed though because of the unknown with my breastfeeding, they gave me a Medela pump to try and draw my supply up, it hadn’t come yet. Finally the last few days I was getting transitional milk and pumping 10 ccs each pumping session.  I would pump after each feeding. It was just barely enough. Grace would feed and I could hear her gulp a few times which was good then after that I would give her what I had pumped by syringe. But I couldn’t bring in any more than that. So I started to get a little worried, because sometimes she had to have what was in the syringe to settle down completely.

The very last day we were at the hospital I had a little bit of a breakdown due to a nurse who I could not stand. She was formerly completely anti-breastfeeding and had no problem admitting to that, where I would have been completely ashamed to admit such a thing if I were her. Here I am struggling with all the unknowns of my supply and I am completely pro-breastfeeding and just can’t stand people like her. Supposedly after going to this workshop she changed her mind and thought she was the world’s foremost expert on breastfeeding and trying to tell me to trust my body and telling me things I already knew, as if I was some kind of stupid person.  She was so dense and new to breastfeeding that she had no idea that for some women there are supply issues and it doesn’t always just come naturally, for a good percentage it does but not all ladies, and for some reason I just happen to be the small percentage of women that struggle. I couldn’t get a word in edgewise hardly to tell her I am not a new mom this was my 2nd baby and my first baby I had major supply issues, as nothing ever came in at all that time. So I just wanted to smack her. I had just gotten Grace fed and she forced me to take her back into the room and feed her again, even though I had nothing to give her and Grace was asleep. So when she left the room I wrapped the baby back up and ate my breakfast with one hand and held Grace sleeping in the other.  By the afternoon when we finally got the ok to be discharged since Grace was in safer billi levels, I was completely ready to be out of there!  She took an already stressful situation and made me feel stupid and incompetent and just angry because she didn’t even start off having any respect for moms that breastfeed most of her career as a RN in the first place, which didn’t set well with me. She thought she could “teach” me more than I already know with her lectures to me. Anyways all I can say is I was glad to be rid of that lady and thankfully she was only on shift my last day in the hospital. I would have gone into a full blown breakdown had I had to stay around her any longer.

So Mother’s day afternoon we can home and I breastfeed for another several days after we got home; and Grace was doing ok at first it seemed so I continued to try my best. The Pediatrician sent me home with a scale and saw Grace every couple days at her office to check on my supply and the baby’s progress. I was only able to give Grace a half ounce at a time I learned with the scale weighing her before and after her feedings and she was needing 1-2 ounces at that point. Then, right at those last couple days of seeing the doctor I noticed she was started to get really dehydrated looking by the look of her diapers and I had to begin supplementing with formula because I just couldn’t give her enough and she also started to show the signs of still being hungry. For a while I kept up pumping but the feedings were so often I couldn’t find the time to pump after every feeding as I wanted, otherwise I wouldn’t have gotten any sleep at all. So it went down to a few pumping sessions a day and then once or twice a day. I was pumping an ounce total for a while, but because of not getting regular stimulation then went down to ½ ounce even with the same amount of pumping. I gave her every drop I could pump. I was happy that I at least made it as far as I did, because with Maddy literally none came in, just drops. So I was relieved she got some breast milk, which is way better that none at all. I had an easier time emotionally this go around, but still felt a bit sad because I so desperately wanted to give her breast milk. I wasn’t mad at myself  but I was sad because I enjoyed the bond during breastfeeding and Grace actually used to beg to breastfeed when I started to supplement and I would let her, but over time she got used to the bottle and didn’t beg anymore. That broke my heart. But at least I know I did my best and gave her as much as I could and that I am proud of.

Having an emergency appendectomy(removal of my appendix) when I hit my 6 week mark pretty much dried up my supply and I was not allowed to breastfeed with the medications I was on, some they could change around to be more breastfeeding friendly but others they couldn’t so I just decided at that point I had to stop and Grace was already receiving most of her feedings from formula. I could have tried to draw it back in, but with the move just a few weeks later and feeding and everything I had very little time to pump.  I would later find on that on both sides of my family women have had supply issues, I had no idea until just a few weeks ago.  I thought just my mom had struggles, so I think with that genetic combination and my thyroid, it’s just how my supply is.

In any case, it was a happy birthday to my Sweet Baby Grace!