Guest post: A doula's path through pregnancy/birth (Part 3: Birth story)

This is the last in my friend and fellow doula Chris's series on a doula's path through pregnancy and birth. Other installments are here:
Intro: All you have to do is be there
Part 1: Prenatal care and education
Part 2: Preparation - physical, mental, and more

I think this is a pretty amazing birth story - Chris has suggested, and I am planning, to do a follow-up post on one of the topics raised in it. Thanks again to Chris for working so hard on this series to share her experiences and knowledge, and thanks to Kevin for writing the birth story in such detail! They are great friends, great parents, and they have just about the cutest baby in the world.

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Part 3:  The Birth

In the days right after you give birth, you think you will never forget a minute of it.  It turns out that’s not the case, and life with a baby (and probably some really awesome hormonal processes specially designed to help you forget pain) makes things get fuzzy very quickly.  Luckily, in the days following delivery while I was dozing with the baby, my awesome rock star amazing birth partner and husband Kevin took the time to write down a very detailed description of the birth from his perspective.  This is the birth story according to Kevin, with my notes added in italics.  

Christine’s contractions started about dinner time on the 9th of May, one day after the baby’s estimated due date.  Her parents were in town and came to the house to make us dinner.  It’s funny now to think back on the unintentional good decisions we made that evening.  For example, I decided to take a nap and then took a short run to perk up before eating a large pasta dinner.  I guess I subconsciously knew I would be working hard that night, so I needed to be in top form.  (I also enjoyed a glass of good whiskey and reflected on our pre-kid years).  

Around 8:45PM, after her parents had left, Christine told me she had a strong contraction that felt different from the Braxton-Hicks contractions she’d been having since the week before.  She hopped in the shower to see if that would soothe them.  When it didn’t, we figured this was the real deal.  Nothing left to do but wait patiently at the house until contractions were 4 minutes apart, drive calmly to the hospital, and push out a baby....easy, right?

By 10:45PM Christine was having trouble focusing on things other than the contractions.  We were halfway through a movie when she decided to move into the bedroom where it was quieter and she could concentrate on breathing through contractions.  She told me I could keep watching, but I knew better than that. My main focus for the previous 40+ weeks was supporting her, and I wasn’t about to start labor by neglecting her to finish watching a movie.

I remember that conversation.  I also remember walking away and thinking “I really should have told him to turn off the TV and just come with me.”  I also remember that he almost immediately showed up in the bedroom with his Birth Partner Game Face on.    

So we moved into the bedroom and started timing and working through the contractions.  Around 11:30PM we called Caroline, our doula, and asked her to come to the house.  While we were waiting for Caroline, I started packing the car.  I also made the mistake of making Chris laugh just before a contraction started. The combination of the two was pretty intense, and she started to 1) laugh harder, 2) cry, 3) shake, and 4) cry some more.  That freaked me out a little; I was worried she was progressing faster than we thought (that she had somehow hit transition) and that we would have to hurry to the hospital or call an ambulance.  Turns out, laughing and contracting were just not a good combination!

I was surprised at what happened when I laughed and contracted (I read a lot of Ina May Gaskin, and she is all about laughing through contractions).  But for me, when I laughed, everything just got all out of control.  I guess I needed to focus on the matter at hand.

Caroline arrived a bit before midnight and confirmed that we were definitely in labor.  We didn’t actually need her to confirm it for us, but it made Christine feel better to know we weren’t overreacting. (I was very concerned about going to the hospital too early).  By now the contractions were about 4 minutes apart, and Christine was working hard to get through them.  She was doing a great job focusing on her breathing and staying relaxed through and between contractions.  Then everything slowed down.  It was a little before 1am when the contractions spread out--first to 8 minutes apart (I thought I had missed one), then a couple at 10 minutes apart.  I figured maybe the baby was just being considerate and wanted us to sleep (I pictured us going to the hospital at 9am alert and totally well rested).  But she faked us out!  I had just made up the futon for Caroline when Christine’s contractions started again--right back to 4 minutes apart.  They were a little stronger, so Caroline suggested the tub.  Caroline helped Christine get situated and started pouring water over her belly as I packed up the last few items for the hospital.  This was the moment I remember thinking “I’m so glad we got a doula.”  

From 2:10 to 2:30 the contractions were 3 minutes apart and gaining intensity, so we decided to go to the hospital.  We hopped in the car and took what seemed like the slowest possible route to the hospital.  I felt particularly bad about the route selection while we were crossing through a neighborhood that had speed humps.  Of course, the contractions seemed to find every bump in the road.  Anyways, we got to the hospital at 3am and entered through the ER.  Caroline and Christine headed up to Labor & Delivery while I grabbed the ridiculous number of bags we packed and took care of check-in at the ER registration desk.  By the time I got up to L&D Christine and Caroline were getting settled into Room 3, which has a tub and is HUGE.  That’s why the staff call it the “Taj Mahal”.  It also faces east, which made for a beautiful ambience in the room a little later that morning.  

It’s important to note what DIDN’T happen when we checked into the hospital.  No IV was inserted, and I was not permanently connected to the monitors. (They hooked me up for the first 15 minutes or so, and after that only monitored me intermittently).  I didn’t have to get into a hospital gown, and there was no prohibition on food or drink.  No one made dreadful statements about my last chance to get an epidural or IV pain meds.  Full credit goes to the midwifery practice for making sure their practices truly support normal and unmedicated birth.  

Our arrival at the hospital marked the point where the labor turned into as much (or more) of a psychological challenge as physical.  When I got up to L&D, The charge nurse escorted me back to the room and asked for the details of the labor so far, and we showed her a copy of the birth plan.  Tanya, the midwife on call, came in to check Christine’s dilation and assess her progress.  We had met Tanya at an earlier office visit and really liked her.  She confirmed with Christine that at her last checkup (at 40 weeks on the dot), her cervix had been 90% effaced and in a good forward position but not dilated at all.  We had all assumed that 8 hours of contractions would have opened her cervix to at least 2-3 cm (Christine was hoping for more like 4-5).  Tanya could see the frequency of contractions from the monitors, and I think she expected to find Christine to be pretty far along as well.  That turned out not to be the case--Christine’s cervix was still completely closed.  

I’d been consistently impressed by the midwives during the pregnancy, so it’s hard to identify one caregiver who stands apart--but I think Tanya (and later Diana) were exactly the people we needed for this delivery.  Tanya immediately recognized that something was off with the progression of labor.  The contractions should have been producing more progress.  It turns out that about 10 years ago, Christine had cryotherapy to remove abnormal cells on her cervix that turned up on a pap smear.  Evidently the procedure left scar tissue on her cervix that was now preventing it from opening.  I’m still impressed that Tanya had the presence of mind at 4am to ask about this right off the bat.  She said she could clear the scar tissue with her fingers, and Christine gave the go-ahead to do so.  It was pretty intense and looked pretty painful, but Christine dilated to 2cm immediately, and her water also broke.  

This is where everything got very fuzzy.  I remember saying “yes, do it” when Tanya asked about clearing the scar tissue. She did it while I was in the middle of a contraction, and I remember intense pain and a gush that turned out to be my bag of waters breaking.  After that, labor felt like something I could just barely hang onto instead of something I was in control of.  It was almost like starting a second, entirely different labor.  It took a while to wrap my head around what had happened and what was happening, and I remember feeling very needy--like I really truly needed everybody in that room to be constantly telling me I was doing well and that it was going to be OK.  That emotion wasn’t one I had anticipated.    

The baby was now on the way for real, but Christine was pretty deflated to find out she wasn’t further along.  It’s also important to point out that dilating 2cm instantly is physically demanding.  Christine’s body was playing catch-up at this point, and the contractions became much more intense.  She got shaky and started shivering, and asked to get in the tub.  

We had talked through a lot of labor and delivery scenarios to try to be prepared for a curveball--what if labor stalls?  What if we needed an emergency c-section? What if the baby needs to go to the NICU? But this situation never crossed our minds.  In some ways it was harder than some of the other things we discussed.  Rather than presenting us with a concrete decision, it placed Christine on a different trajectory, and she dilated faster and delivered sooner than she would have if she had truly been at 0cm at 3am.  The labor went from feeling manageable for Chris to feeling like something that she could just barely hang on for.  

The contractions before and after my water broke were very different.  Before, I could stay in control and breathe through even the most intense contractions.  After, I remember feeling pushed to my absolute limit with every contraction.  I lost all composure and really needed Kevin and Caroline to help me refocus after each one.  I remember feeling restless or almost trapped, and having that back-of-the-throat almost-scream feeling.  They would talk me down and get me to breathe and relax and make productive noises.  

I’ve been able to provide pretty good detail so far, but things sort of blend together from this point onwards.  Christine stayed in the tub, and Caroline and I stayed next to her and did our best to help through contractions.  I would remind her to breathe and relax, and Caroline would provide comfort measures (hand holding, water on the belly).  Unfortunately, the hospital only has regular-sized bathtubs, so it’s difficult to get the belly all the way in the water.  Christine had great support, but she was doing all the work.  One thing I told her repeatedly was “No one is more prepared for this than you”.  It’s true--she was as ready physically and mentally as any first-time mom could be.  Some women would have caved under the mental strain and physical pain, but my wife is TOUGH.

One thing that didn’t cross my mind during labor but I have thought about a lot since then is the fact that, in accordance with our birth plan, no one offered me pain medication.  In the end, I think this made all the difference in my ability to have an unmedicated birth. I really believe that if someone had asked me when I was at about 7 or 8cm if I wanted an epidural, I would have said yes in a heartbeat.  But as it was, I was so far into the labor zone that I didn’t even think about medication.  And since no one brought it up, I just kept doing what I was doing and it turned out exactly how I hoped.  When I was a doula, I don’t think I understood how important the not-asking was.  I thought “Well, if they ask, you just say no.”  Now I get it.  Having an unmedicated birth depends on a lot more than just previous intention and willpower.  

One thing Chris needed a lot of was reassurance.  She really needed to hear “Yes, you’re making progress” and “Yes, it’s moving quickly”.  She asked Tanya to check her a couple of times while she was in the tub, and each time she had made progress.  By the time she was dilated to 6cm, I was standing in the tub to help support her through contractions and to give counterpressure.  Before I knew it we were at 8cm, we had moved back to the bed, the delivery instruments had been prepared, and we all thought Chris would be pushing at any moment.  It was about 6:30am, and Christine had dilated from 0-8cm in 3 and a half hours.  Christine’s mom arrived sometime around then, and I remember Chris asking “Mama, how did you do this twice?”.

We tried a number of positions on the bed, but Chris was most comfortable on her knees, leaning over the back of the bed (which we had put in the full-upright position).  By 7AM she was having a LOT of back pain.  I was applying counterpressure with each contraction, and LeeAnn (our nurse) and Caroline were pushing against Christine’s hips.  I was also massaging her back with raquetballs between contractions (I had lots of tricks in my gypsy bags).  It took almost two hours to get through transition, which was slower than anticipated given how fast she had gotten to 8cm.  The baby had been anterior all through the pregnancy and had been low in the pelvis for some time.  It seemed unlikley she would have rotated to a posterior position during labor, but the nurses and midwives started to wonder about it since things had slowed down and Chris was having so much back labor.  I was concerned because she had worked so hard all night long, and I was worried she would start to run out of steam if pushing was very difficult.  When she finally began to push (around 8AM), it wasn’t an overwhelming need.  She would push a little but then stop halfway through contractions, saying it was all she could do.  

I had lost all concept of time by this point.  I remember being upright on the bed, leaning over the back and moving my hips constantly.  I couldn’t stop it, even though I was so tired.  I remember Caroline standing by the head of the bed feeding me Craisins between contractions.  I remember that eventually, the pain never went away, even when I wasn’t contracting.  I think I said “the baby is going to come out of my back”.  And I remember that I did not like to push.  I never had an overwhelming urge, and when I did push, I could only do it for about half of a contraction.  After that the pain was too much and I just had to breathe.  But nobody was rushing me or counting or telling me to hold my breath and push for longer.  They let me figure it out on my own.

Around this time the midwives had a shift change, and Tanya handed the reins to Diana and Angela.  (Since Diana is new to the practice, Angela was there to back her up).  I took shift change as an opportunity to consider our options for getting Christine some rest or pain relief.  We wanted an unmedicated birth, and the nurses and midwives were great about not offering epidurals or other meds after the very first time (I think they were required to have her do the pain scale and confirm that she was aware of medical pain management options upon admission). But I wanted to talk through our options in case we didn’t get things moving again, or if Christine turned out to be too exhausted to push.  Christine was SO tired, and I thought that if we got something to cut the pain, she may be able to rest a bit and come back at it with more energy.  

Pushing was a struggle at first.  Christine had a hard time finding a comfortable pushing position on the bed and was struggling to activate the right muscles.  LeeAnn reminded her that you need the same muscles you use for a bowel movement, which may have been what got Chris thinking about the toilet, so we headed to the bathroom.

I also remember LeeAnn being really hands on.  She took my hands and looked right in my eyes and told me that I had to find the exact place where it hurt the most and push straight into it, even though that felt like the last thing I’d ever want to do.  And she was right.  She pretty much taught me to push.  

While Christine labored in the bathroom, I stepped out into the hall with several of the midwives to discuss what might come next if Christine was too tired to push.  We were all hoping no intervention would be necessary, but it seemed wise to have the discussion before things got urgent.  There was talk of Nubain to cut the pain and provide some time to rest, asking the MD on call to scrub in and see if the baby's head could be rotated into a more favorable position, and vacuum extraction as a last resort.  (I remember having the feeling that if I didn't start making some good progress with the pushing, people were going to start suggesting things that I didn't want to hear.  I was already pushing, but at that point I started pushing like never before.)  While we were talking, Diana (the new midwife on call) was with Christine while she pushed.  When she joined us in the hall, I asked for her thoughts on how things were going.  She replied that she wasn't sure whether the baby was posterior or not, but she felt like Christine was making progress with pushing and the best thing to do would be to give her some more time to work before suggesting anything else.  That's what we did.

Diana and I went back into the bathroom, and before too long the baby was crowning.  Diana told Christine that if she wanted to move to the bed, now would be the time, but staying put would be OK too.  Chris made an attempt to get off the toilet but could barely stand, and she promptly decided that moving was out of the question.  Diana said, "No problem.  We can deliver here."  So Diana settled in cross-legged on the floor, and the nurses brought the instruments into the bathroom (which, by the way, was huge).  As Diana was prepping for the delivery, a contraction started.  I was squeezed up next to the wall still giving counterpressure, and LeeAnn and Caroline were right next to me holding Christine's hands.  Christine needed to get further forward on the seat so that Diana could have a better angle to protect the perineum and deliver the baby, so I got behind Christine and held her up by the arms.  Diana kept asking me to move her forward more and more until before I knew it I was sitting on the toilet and Christine was on the ends of my knees and I was supporting her with my forearms.  I'm honestly not sure how long we pushed that way, but my legs were numb. With one contraction Christine got very loud, and I thought "this must be it!"  Diana looked up and said "Christine, get control of yourself, you're almost there, keep breathing."  I could tell a difference in the next push--Chris was squeezing my hands and I could feel her core muscles working.  With the next push, I think we were both screaming, and then I actually felt the baby come out--I could feel all of Christine's power while she was sitting on my lap.  There was a little tug, and then Chris relaxed, and moments later Diana lifted our baby Annie onto Christine's chest, and I was sobbing as hard as the baby was crying (she had powerful lungs from the get-go).  It was just after 9:00AM.  After a few minutes LeeAnn took over my position behind Christine so I could cut the cord, and then we helped Christine walk back to the bed and lie down.

Annie was the most incredible beautiful thing I had ever seen, and I was completely overwhelmed by the delivery.  Christine had been so strong and worked so hard to grow our daughter and bring her into the world.  Experiencing her birth that way was more powerful than I could have prepared for.  It is (and will remain) the most amazing experience of my life.  Our Annie girl was finally with us after so many months, and I fell in love with her in an instant.

I have snatches of very clear memories of the delivery--of squeezing Kevin's hands harder than I had ever squeezed anything, of bellowing louder than I ever expected to, of Diana's face asking me with intensity to get control and breathe, and of this huge feeling of relief when I held the baby for the first time.  I still don't know how I walked to the bed, because an hour later I couldn't stand.  I had second degree perineal tears that Diana stitched up, and the entire time nobody even suggested moving Annie off my chest.  We just rested together.

It turned out that the reason labor had slowed so significantly during transition (and the reason I had so much back labor) was that Annie was born with a nuchal arm--she had one arm extended by her head upon delivery, so she came out Superman-style. (Interestingly, she had an arm up by her head as early as the 20-week anatomy check ultrasound, and I wonder if she didn't just keep it up there!)  She was 7lbs 5oz, born perfectly healthy after around 12 or 13 hours of labor (though all the cervical dilation happened in the last 6 hours).  There was a lactation nurse beside the bed before I even realized it, and she helped Annie and I nurse for the first time maybe a half hour after delivery.  When we were ready, Kevin went with the nurses to do the rest of the newborn exams and give Annie her first bath while I ate some breakfast and moved to our room in the Mother-Baby unit.

If you ask most women who have given birth what they remember about the experience, they'll tell you that it's hard to remember much.  While preparing for Annie's birth, I had a hard time fathoming how one forgets such an important experience.  Now, nearly 6 months after the fact, I can tell you that the forgetting is the absolute truth--it faded a little bit every time I held the baby or nursed her or napped with her.  All those fuzzy details just got fuzzier (I'm so glad Kevin wrote everything down so soon after the delivery!), and what I'm left with is an overall impression of the experience.  I am very lucky that it's such a positive and empowering impression.  When I think back on the birth, I feel proud of myself, but more than anything I feel grateful--grateful for the support I had, grateful to have medical care that truly supported normal birth, grateful for the physical and mental strength to give birth the way I wanted to.  And most of all, I'm grateful for our beautiful daughter, who made such a memorable entrance and has been making life more exciting ever since.  

Guest Post: Mollie's path to pregnancy/birth (Part 1: Preconception)

You may remember that a few weeks ago I posted about my friend Mollie's birth story, in which she had a lovely and exciting (in the good way) delivery in a birth center, attended by a midwife, with the support of her husband and doula. I also promised a guest post by Mollie. So now you know the end of the story, I'm delighted to bring you a three-part series that she's written about how she came to learn about her options for birth, decide what she wanted, and find her care providers and place of birth.

Of note, Mollie and I met a surprisingly large number of years ago (surprising to me at least! I don't feel that old!) living on the same dormitory hall, at a college known for having its students do a lot of independent, self-guided research. As you can see, Mollie learned these lessons very well!

Mollie's path to pregnancy/birth: Part 1: Preconception

The path to becoming a mother is different for everyone, as is the path to getting pregnant. My path was in many ways straightforward – get married, get settled, get pregnant, have baby. I did manage, however, to insert a step in the process which, for anyone who knows me well enough, was absolutely essential: I researched the crap out of it. I left no pregnancy book unread, no birthing blog un-lurked, and no midwife in a 10-mile radius without at least a hit on her website. I needed to know it all, and I needed to know it all before there was even a fetus to worry about.

It all started about 15 months or so before the baby was conceived. I was on The Pill and was interested in a non-hormonal form of birth control. I chatted with some friends and with my GYN, and ultimately picked up “Taking Charge of Your Fertility,” a fantastic how-to guide for the Fertility Awareness Method of both birth control and conception. I devoured this book! I couldn’t believe how much I realized I had never known about my own reproductive system. “Why didn’t they ever teach me this in health class?” I kept yelling! I couldn’t get enough of it. I charted my cycle for over a year before ever attempting to get pregnant, and I learned more about my hormones and my body in that year than in my previous 15 years as a reproductively mature female.

Now it was time to research conception, because who could POSSIBLY do that without adequately researching it!? [har har]. So I picked up a few books (and thank you New York Public Library, for allowing me my fill of research without having to purchase a single book). “Your Pregnancy: a 90-Day Preconception Guide” was pretty informative – a lot about nutrition and vitamins, exercise, and understanding genetic diseases. I went back to “Taking Charge of your Fertility” and reread the conception chapters. I also picked up “What to Expect Before You’re Expecting” . . . oy. If you thought the “When You’re Expecting” book was bad, the “Before You’re Expecting” may just give you an aneurism. Unless you’re not quite sure on the mechanics of sex leading to babies, don’t waste your time with this one.

Alright, so I had conception down. I had negotiated with the husband to start trying in September, so on June 1, 90 days out, I started my preconception routine: I was taking my prenatal vitamins (woo Folic Acid!), charting away, and trying to convince my husband that “no, I promise I won’t go crazy and tell you which days we have to have sex!” I made an appointment with my GYN to get checked out, talk through which medications were still fine to take, and discuss genetic testing.

At the same time I had the “Why didn’t I know this about my body” epiphany, I had the “Why didn’t I know this about childbirth” epiphany. The Public Heath Doula herself invited me on a little movie date one afternoon. “There’s this documentary about childbirth that’s supposed to be great!” she told me. Little did I know I would soon become one of those Natural Childbirth advocates who feel the need to educate the world about epidurals and yell at sitcoms which portray childbirth incorrectly. Because, you see, she took me to see “The Business of Being Born.” I’m not exaggerating when I say it changed my life, or at least my outlook on life. If you haven’t seen it, you need to. If you ignore everything else I write here, if you take away NOTHING . . . just see this film. It’s on Netflix instant-watch, and it’s only an hour or so long. I promise, it’s worth it. And get your partner to watch it too. I’m telling you, my husband was on the fence about this whole non-medicated thing (“If it makes the pain go away, why WOULDN’T you want it!?”) until I sat him down and made him watch this movie. He now excitedly educates his buddies about the side-effects of epidural analgesia and hospital policies on freedom of movement. (He still wasn’t sold on a home-birth, but he eased up on the opinion that I was effing crazy.)

Stay tuned for Part 2... Preparation!

Mollie's birth story

My lovely friend Mollie just had her baby last week and I am so happy for her! She just posted her birth story on her blog. Before she had it written, she e-mailed me a teaser:

Chris is dozing in the room, I'm in the hall with the Doula, midwife had gone to lie down. We walk down the length of the hall, back to the other end, about half way back and then...
Chris tells it as "I was about to doze off, and then I hear her yelling, 'I can't do it, I can't do it, I'm pushing, make it stop, something came out!'"

Doesn't that make you want to read the whole thing? (Plus you get to see photos of that cute little baby.)

Stay tuned for a guest post by Mollie on how she went about choosing her care providers and place of birth, laying the foundation for a positive (and exciting - in the good way) birth experience!

Doula memories

I've been puttering around today, catching up on some of the things I put off while getting ready for the exam. Some of my friends have been talking birth stories/birth plans lately and we talked a bit about wanting positive hospital birth stories since there are so many scary ones out there and yet there CAN be such lovely births at the hospital.

I started thinking about a birth I attended back when I was in AmeriCorps and went searching through my old birth stories (we wrote one up for each birth we attended, and when I left I kept a copy of all of mine and am SO glad I did - they are wonderful to look back through) to find what I wrote about it at the time. And I cannot for the life of me find it. I must have missed it when I was making my copies.

So, without that sheet of paper I can't remember all the information about the birth, like whether mom had an epidural or not, what # baby this was for her, even whether baby was a boy or girl! But I do remember that the family had a few older children, some of whom were present, and that they were very positive, friendly people - I really enjoyed being at the birth with them. There was a recently hired (but experienced) midwife at this hospital that I hadn't worked with before* and she was the midwife on all day as mom labored and I worked with her.

As the birth grew nearer, and mom was working hard and pushing, the midwife beckoned the dad over to where she was keeping an eye on the perineum. Baby began to crown and she said to dad, "Come here. Give me your hands." As the baby's head emerged, she laid his hands on the baby's head and guided him in catching his own baby - the first person ever to lay hands on his child. I watched his eyes widen, his face about to split apart with a smile as he did it. Together they handed baby to mom and she cuddled her new baby as they got baby cleaned off.

Afterwards, dad was just glowing, literally bouncing around the room, still unable to wipe that huge grin off his face. "Did you see that?" he kept asking everyone there. "Did you see what I did? That was amazing! It was AMAZING!"

It was even neater - to me - because these were not people who had sought out midwives to get greater control over the birth process. They were community health center patients who just needed quality affordable prenatal care, and ended up working with midwives because that's who did the births for the CHC at that hospital. And they were handed this really amazing gift of participating more fully in their child's birth.

Later the midwife told me that she had been watching me work with the mom all day, and had been going to offer ME the chance to help catch the baby, but could tell how excited the dad would be to do it. I was bowled over by that! I told her I was so glad she had the dad catch. I was just there for one day, but I hope that every year on this baby's birthday, that dad is still telling his child the story of how he helped catch him/her, and how proud he was to do it.

So that's your wonderful hospital birth story of the day, courtesy of my free association skills!

*Do any other doulas have the experience with new-to-the-system midwives that they're such a breath of fresh air? They haven't gotten trampled down by the system yet, they're not looking over their shoulders at the nurse who might "turn them in", they're just practicing how they want to practice. That's not to say that experienced midwives who know how to work the system aren't fabulous and valuable and just as subversive in their own ways - if not more - but being with a new midwife can be so...liberating.

Beautiful birth video!

Gorgeous birth video, done by the mother's sister who is a professional videographer. (Of course I cried - the music in birth videos always makes me cry!)

Theo's Birth video from hailey bartholomew on Vimeo.

Mom's birth story with pictures is here.

I just loved this video. Lovely music, beautiful images, calm water birth in a birth center, and check out the size of that baby, too! Score another one for the big babies!

Reply turned post: Warning: this post contains the word "rectal"

Jill at the Unnecesarean recently wrote about out-of-bed birth and the Captain Morgan aspects of one of her births (you have to read it to fully appreciate). MidwifeNextDoor commented:

"Good for you! I am a CNM presently (reluctantly) working in the hospital. I've only done two out of bed births so far, but it freaks the nurses out! One nurse's chart notes on a patient went like this (the woman was pushing when she arrived at the labor ward):

"Patient REFUSES to give urine sample. She is standing by the side of the bed. I have repeatedly told her to get up on the bed, but she refuses. She stated, 'Women have been giving birth standing up for thousands of years and SO CAN I! And then she pushed the baby out. I did put gloves on before the baby was born."

This client of mine was a VBAC client, by the way! I didn't make it in time for the birth, obviously. I've done one bathroom birth, with mom on hands and knees, and one side of the bed birth with mom standing. There is so much fear surrounding anything different from the cockroach position (flat on your back, legs in the air) that it makes me stressed.

Would love to see more women refuse to get into bed."


This jogged a doula memory for me and I contributed my own comment/story. Since several people thought it was pretty funny I thought I'd repost it here:

"MidwifeNextDoor, your comment about the nurse's charting was so funny!! It reminded me of a birth one of my fellow doulas attended when we were in AmeriCorps together. There was a new CNM at the very by-the-book, public hospital we often attended births at, and she had trained in birth centers down in New Mexico. I can't imagine she's still there but at the time she was fighting to carve out a little sphere for normal birth, and we loved her for it.

One day she paged for one of our doula team to come in to a birth there because she knew the mom wanted to go unmedicated and felt like the nurse wasn't going to give her enough support. My teammate was on-call and told us the whole story later. I can't remember the exact details anymore, but it went something like this: When it came time to push, the unsupportive nurse really couldn't handle the hands-off approach. Mom began pushing standing up next to the bed and the nurse freaked out and said "She's pushing!" "Yes," the midwife said calmly, "she is." The nurse began to get huffy and started charting about the patient pushing STANDING UP. "What's her dilation?" the nurse asked. "Oh, she was almost fully dilated," the midwife said, "I'm sure she's complete now." The nurse went back to charting about how the midwife did not check but just SAID the patient was complete. The nurse at this point swings the computer around so her back is to this travesty. Whenever the midwife asks for a chux pad or anything else she needs, the nurse gets it for her and then goes back to charting with her back turned, so the midwife starts asking the doula to hand her things. As the baby descends, the midwife takes note of signs of progress and says "Could you please chart, 'positive rectal bulging'?" "WHAT?!" says the nurse. "POSITIVE RECTAL BULGING," the midwife says loudly, and she and the doula grin at each other. (Fortunately mom was Spanish-speaking and probably not paying any attention anyway so she wasn't privy to all this banter.) Shockingly, baby is born without any need for mother to get into bed, or for nurse to do much but stand with her back turned and chart ;-) "Positive rectal bulging" became a catchphrase around the office for a while.

Side note: after the baby was born, mom did get into bed to rest and cuddle with the baby, and the doula told the mom what a great job she did, how impressed she was, etc. She asked half-jokingly, "So, do you feel like you could do anything now?" and the mom looked up and very matter-of-factly said, "Oh, YES." "

Back-to-school birth story

It's funny how life works. The year after high school I was a Rotary exchange student in Sweden, and Tralee was another exchange student in my district (she was from another part of the U.S.). We saw each other at various Rotary camps and weekends; she was always wickedly funny and kept all of us students laughing with her stories and (mis)adventures. Our common bonds were forged over a love of Swedish candy and the trials and tribulations of exchange student life.

After we came back to the U.S. Tralee and I kept in occasional touch and even managed to visit a couple times despite being on opposite coasts. The funny thing is that somehow over the past decade we have both independently come to a place where we are very involved in birth/breastfeeding - me through public health and doula work, and Tralee through her experience of becoming a mother and educating herself extensively. I saw her earlier this year when she was pregnant with her second and planning a home birth, and she's now posted her birth story. I love this quote:

To me birth is natural, not painful...yeah a little discomfort but every contraction was helping me, every moment was me experiencing me. I looked forward to each new phase, like a runner trains for a marathon...after so much prep and training you think ”yeah come on, bring it...bring on that hill, I can do this."

Congratulations to the Knapp family! I can't wait to see you guys again.

As for me, I'm back at school, getting ready for classes to start next week...including my lactation consultant course! I am excited and also a little nervous. More posts coming soon!

Cesarean vs. VBAC

Via The Unnecesarean, who says "Alexandra Orchard is my personal hero":

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

While there are a lot of things I loved about this video (the honest portrayal of cesarean surgery, for one), the letter is what really blows me away. I would love it if more women who are disappointed with their care providers and hospitals openly expressed that disappointment. Nothing is going to change without better communication and who better to speak than someone speaking from immediate personal experience? It's hard for doulas to push that too much with individual clients, but it is inspiring when women and their families take the lead.

New webisode series - celebrity births

Ricki and Abby are at it again! Next up it's a celebrity webisode series, of celebrities discussing their births. I kind of wonder what the exact point of it is - just judging from the trailer, there seem to be some alternative birth choices in there (Laila Ali having planned a home birth, for example), although not all. Maybe the idea is just generally to attract more attention to the fact that there ARE choices in birth by having celebrities talk about their choices. Anyway, I'm a sucker for both birth stories and People magazine, so it sounds OK to me.



Via Empowered Birth.

Pregnancy and birth stories, pictures, linky goodness

Pregnancy and natural childbirth from a father's perspective. It's a nice perspective, gently poking fun at some things he's surprised but generally curious and open-minded.

These are just beautiful pictures from labor and birth.

Beautiful vintage breastfeeding poster!

A baby born in the caul, under water! If it's true that babies born in the caul are specially gifted, then there are few babies in this country getting that gift these days...

Singing in labor - much as I'd like to imagine someday singing beautiful music all through labor, since I can't sing it now I think I'll have to abandon that dream!

Another nice birth story with lovely pictures. I especially like the one of the dad cuddling his newborn skin-to-skin.

As I've said before, I'm trying to post the positive and beautiful - not just the maddening and intolerable. I hope these links provide some uplift :-) (Along with the new bras you're buying, right?)

Traveling times

I've been packing, moving, and traveling for the past week and will be packing, moving, and traveling for the next two weeks! So little (if any) posting, and little (if any) comment moderation (so comments may take a while to show).

Once I'm settled in my summer digs, I will hopefully be posting again. In the meantime, I leave you with some of the links that have been piling up in my Google Reader "starred" section:

The Hazards of Feeding While Mothering - this is just right.

Is health an additive or multiplicative process? Could we think of birth this way too?

Initiation of breastfeeding by breast crawl - these videos are always so neat to watch!

What it takes to VBAC in Rural County, from the great Rural Doctor blog.

You know all those birth stories I link to? This one is a comic!

Two more great birth stories/videos

Have you added Nursing Birth to your feed reader? Because while I would, I can't link to every single one of her posts - this blog would start looking like kind of a rip-off. She's a great storyteller and has important stories to tell!

And here are two more great birth links:

Rixa at Stand and Deliver just had her baby and has posted his birth story along with videos from right after the birth. A great story and sweet little baby! Congratulations, Rixa!

Diana at Birthing at Home in Arizona posted this great video of a hypnobirth (although not hers) (it's a bit long, the birth happens toward the end but what's so notable is how calm and peaceful things are throughout.)

Score one for the big babies!

Earlier this week, my phone rang in the early afternoon from an unfamiliar number. It turned out to be the husband of doula client, telling me she was in early labor. Those are such fun phone calls to get! I spent the rest of the afternoon studying for my comps, checking out a couple of apartments for next year, and anticipating going to a birth...the last one for a while.

Around 7 pm I got a phone call that they had just checked in at the hospital and she was 6 cm. I knew she was a primip, but that call still sent me careening around the apartment, throwing off my clothes and throwing on my doula outfit - I grabbed my bag and was out the door in probably less than 5 minutes. I didn't think she'd go fast, but I wanted to make it if she did!

When I got there, she wasn't going fast but things were getting more intense. She couldn't sit down, or lie down - she had to be standing or kneeling by the bed, where she would lean over the birth ball and rock back and forth, and vocalize loudly. Her husband was an amazing support, a great cheerleader who said all the right things, very hands on (although she didn't always want to be touched). I just backed him up, encouraging her, rubbing her back, bringing her water. She turned to me at one point and said, "What's transition like? Because I can't imagine it getting worse than this." I said, "For all we know, you're in transition!" I suggested she try the shower and she stayed in the bathroom in the shower/tub for at least an hour. It's a tiny room so her husband stayed in with her and we just checked on them once in a while.

Noticed anything yet about this scene? She was not hooked up to ANYTHING! She had even declined a heplock for the IV (she hates needles, this was a big priority.) She was getting intermittent monitoring probably every half hour or so, but very briefly and every time the nurse would say, "You don't need to move for this. Just pay no attention to me." She could go wherever she wanted, sit, stand, rock, get in the tub - no restrictions. There was another doula working with her who got there a little later, and she said, "Oh, it's so great how there's nothing attached to her. I haven't been to any births like that lately!"

After she got out of the tub, she really wanted to know what we could do to speed things up, and agreed to have her water broken (after being checked and almost complete!) The midwife really worked proactively with mom's positioning to get the baby rotated optimally, and after a while she began pushing spontaneously. It's been a REALLY long time since I've seen someone allowed to do that! Only because she was so intent on speeding things up, the midwife did some gentle coaching on pushing. The midwife also kept her position changing - hands and knees, side - to keep the baby rotating well. In under an hour, baby was at the perineum and crowned at the end of a push. The midwife let the half-out head sit there until the next contraction - which took a little while - and just encouraged the mom to pant and let the head emerge slowly. Once the next contraction came she was out in two more pushes, crying right away, a big baby girl!

How big? Over 9.5 pounds! Over an intact perineum!

This birth was so invigorating and inspiring. This mom got almost every one of the wishes on her birth plan respected and supported by her birth team. Whenever she said, "I can't do this!" no one said "I can have the anesthesiologist come and talk to you if you want." Everyone said, "You ARE doing it, you're doing great, you're so close." She could move freely and do whatever her body told her - she was never attached to anything except her brief stint on the monitor and the occasional blood pressure. No one got in her face and yelled at her to push or counted to 10, just explained to her that the longer she could hold a push, the faster it might go. She had a midwife who paid attention to the baby's positioning and used it to guide mom's positioning. And she had a great midwife who let her push slowly and did a very controlled and gentle delivery.

So often after a birth that ends in c-section, I run through the "what ifs". This birth is one where you can easily run the what-ifs in reverse: what if she HAD been induced? Then she would have been hooked up to the IV and the monitors and could at best have only stood next to the bed. What if she hadn't been able to use the tub? Then she might have asked for the epidural. What if she'd gotten the epidural? Then she might not have been able to change positions, and would have had a big OP baby. What if she hadn't been able to push effectively? Then a long pushing stage and possible c-section (and "No wonder you couldn't push this baby out, he's too big for you!")

What if! Hopefully even if those had happened, the cascade wouldn't have gone all the way to c-section, but it's easy to see the potential pitfalls, and I am so glad it went the way it did. This mom prepared so well: by taking a class so she knew what her options were and what to expect, writing out a simple, clear birth plan with her most important wishes, and above all choosing a birthplace and care provider that matched her needs.

So score one for the big babies! And score one for women being informed, respected and empowered.

I am sad that this will be my last birth for a few months, but I'm looking forward to the fall, and to a summer practicum that will give me the skills to crunch the numbers to provide the evidence base for empowering births!