The Birth of Theodore Atticus…It’s a Boy!

I am SOOOOOO excited to share this birth story with you all. I have been following Sally and her little family since way back when I still used blogger and had a different blog name. This birth of her third boy is beautiful, but it involves a pretty scary postpartum hemorrhage (PPH). I irony in reading her story this weekend was that last week I had a patient have a PPH. It does not happen very often but when it does, it sticks with you. I find myself reflecting on every moment, each little step we made to help the patient feel calm, safe, and stop the bleeding. As Sally mentions in her post below, the care a patient receives at any time is critical but especially so when something scary happens. Feeling like you’re going to die after giving birth is probably one of the scariest thoughts anyone can have. Thank you, Sally, for allowing me to share Theodore’s birth story.

***

Theodore Atticus (Teddy) arrived on Wednesday morning at 11:13AM after almost twenty-four hours of labor. I want to go ahead and give the heads up that, much like my other two births, this labor and delivery did not go exactly as planned. If you’re looking for a natural birth story where every thing goes to a T, you should probably skip this one. However, unlike the others, I had such a better experience when it came to feeling supported and listened to during my experience. My hospital staff was absolutely incredible. My nurses were amazing. The OB who delivered Teddy was perfection. Here’s our story:

teddy3

Monday was Memorial Day. At our CrossFit box, the gym was running a hero work out known as “Murph.” Taylor and I got there with the boys around 10:30AM to cheer on the athletes and get a little work out in ourselves. I headed to the squat rack and started doing a slow triplet of three squats, three pull ups, two sled pushes. I added a little weight every round, and I had just done my second squat at 115lbs when I felt a thump. I stood back up, and water gushed down my legs like someone had turned on a bath tub faucet. I racked the weight, turned to look at Taylor, and said, “Um, Tay, my water broke…we need to go.” He started laughing, and we gathered up the boys while I waddled to the car with a towel between my legs.

We were supposed to show our house that morning, but obviously, that wasn’t going to happen. I hopped in the shower while Taylor fed the boys. We made calls to the people who were coming to help watch Sully and Arlo while we were at the hospital and before our families arrived. I went back and forth between the birth ball and sitting on the toilet trying to get some contractions going. They were there, but very mild and not at all consistent. At about 2:30PM, we decided to head on to the hospital. I was GBS+ again, and honestly, being at home was far from relaxing between the kids and the dog. Our good friends arrived to watch the boys, and we made our way.

When we checked in, I was still not having any contractions and was at about 2cm. I walked and walked some more, bounced on the ball some more, and four hours later, still nothing. At this point, I agreed to being put on the lowest level of pitocin in order to hopefully get contractions going. The nurses and OB were all absolutely fine with me walking around, taking a shower, doing whatever I could to try to get things moving. Eventually, the contractions picked up. They became incredibly uncomfortable, but they still were not regular. After about six hours on pitocin, they took me off and checked me again. I was at 3cm. We decided to let me try to labor on my own for awhile off the pitocin to see if I could try to progress some more. For several more hours, I labored in the shower, on the ball, in the bed, whatever I could try to do. The contractions were steady, and I would say they were very painful. It was intense pressure with each wave and very little rest in between. I asked to be checked again, convinced I had to be close. I was only 3.5cm. After being in labor this long, looking at the middle of the night, and recognizing that I just wasn’t progressing like I wanted, I asked for the epidural. I needed rest, and my mom and Taylor were exhausted, too. I hoped an epidural would bring some relief and let me sleep. I honestly could have kissed the anesthesiologist. I told him my epidurals before had never really worked, and I always ended up with “hot spots.” He had to place it twice, but he finally got it working, and I could rest.

I expected to be disappointed by this choice. After all, I really wanted to go naturally. But after having been in labor for so long with no change, I felt like I was only torturing myself. Labor should an experience where you feel in control and on top of all the decisions made. I truly feel like I was in control this time. Every decision made was passed by me and approved by me, and the nurses and OB were so amazing at ensuring my experience was the best possible one for me. I laid down and rested and by 10:30AM, I had a little lip of cervix between me and baby. The anesthesiologist had to do another dose of medicine when I started getting hot spots, but it fixed the problem. My epidural was light enough that I could feel all the contractions and pressure, and I could move my legs, but I was no longer fighting against the contractions. When it came time to push, three pushes, and Teddy joined us, screaming and pink.
___________________________________________________________________________________

Now, here’s the hard part. My labor and delivery went so well. I had one tiny tear that required a few stitches, and I was able to get up and walk around almost immediately after Teddy was born. He latched like a champ and took to nursing right away. About six hours after delivery, while we were settled into our recovery room and after my shower, I got up to use the bathroom. As I walked into the bathroom, I felt a ton of pressure and cramping. Suddenly, blood gushed everywhere. Huge clots covered the floor, and the walls looked like a horror film. I yelled to Taylor to get the nurse, and more blood gushed again. I stood there completely shocked, and the nurses rushed in. They put me in the bed, where the gushes kept happening. Soon, my room was filled with nurses and my OB. They gave me percocet, a shot of some of sort, and cytotec to try to stop the bleeding. The OB then explained to me she would have to do a manual extraction, where she would have to reach up into my uterus to pull out the massive clots that were preventing my uterus from contracting back to normal size and containing the bleeding like it should have.

I have never had anything done that felt so horrific. I was screaming and crying and begging for them to stop, but they were pulling out baseball sized clots of blood, and I knew it had to be done. I think this was the point where I honestly thought I might die. I’ve never seen so much blood in my life, and I have certainly never seen so much blood come out of someone and them still live. The OB explained that if they couldn’t stop the bleeding, I would have to go under anesthesia for an emergency D&C and then possibly a hysterectomy if it continued. Once the manual extraction was over, they began a blood transfusion. I received four pints of blood because it was estimated I had lost about two liters (the human body generally has 4.7-5 liters of blood). They pumped me full of fluids. This part is pretty hazy, but I remember being cold and not being able to stop shaking. They kept asking me how I felt and random questions to keep me alert. Poor Taylor and Teddy had to be there the whole time.

Once they had me stabilized, they inserted a postpartum balloon. It was basically a massive balloon that they filled with water to put pressure on my uterus and hopefully help the blood vessels seal. They kept it in overnight, and in the morning, they removed it. I had no more clotting, so I was asked to stay in bed twelve more hours before I started moving around. They kept me another couple of days, but I was finally in the clear.

They speculate that my long labor exhausted my uterus, and when it was time to contract back to normal size, it was contracting but not shrinking. Blood vessels never sealed, and it started a vicious cycle of clotting, releasing the clots, and clotting again. There is no real way of knowing WHY this happened.
_________________________________________________________________________________________________

I can tell you a few things about this experience:

1) Teddy was our last baby. I can’t risk something like this happening again. Thinking I was about to die was the most terrifying thing in this entire world, and while he is so, so, worth it, I want to be here for Taylor and my babies.

2) I appreciate my little family so much more.

3) I am so incredibly grateful for my medical team. Had I given birth at home or had I been released earlier than 24 hours, I would have bled to death. An ambulance would not have made it in time for me to survive. Which means, if I had birthed anywhere but the hospital, I wouldn’t be here today. That does not mean that I am against home or birth center births, but this experience made me realize how grateful I am that I personally did not chose that path.

4) Having a good hospital staff and OB makes an absolute world of difference. My labor and delivery could not have been more precious to me. My OB that had privatized me the entire pregnancy was actually out of town. I ended up with another female OB, Dr. Jones, who is my new best friend. She was so incredible, and I am so grateful I had her. My nurses handled our labor and following emergency so well. No one panicked or made me feel like they were not in control. Even at the worst moment, Taylor says he did not really think he would lose me because everyone was so competent.

teddy4

_________________________________________________________________________________________________

We are home and settled now. I feel pretty rough, but I guess that is to be expected. Teddy is nursing so well, and the big boys are loving him. Teddy has a little jaundice, but we are staying on top of it, and his numbers are lower today, so we feel better about that. I am so grateful things turned out the way they did, and now we are just hunkering down to enjoy this newborn phase.

Advertisements

Homebirth in the Hospital

For my Human Sexuality class, I had to pick a topic (childbirth) and write a research paper on it. Childbirth is a very wide term that incorporates so many different areas of birth. Below you will read my paper. It is long and, according to my professor, has some technical errors. Poo poo, I say! 😉 Enjoy!

****

Giving birth, for many, is one of the most life-changing experiences one can go through. Whether it’s for the first or fifth time, every experience can be different. In the US, women have discovered ways to control her pregnancy, labor and the birth of her baby. She has many options which include giving birth at home with or without the assistance of a medical professional, in a birth center with a midwife or in the hospital, with an obstetrician or nurse-midwife. Safety concerns and control over one’s body seems to dictate how and where a woman chooses to give birth. While the safety concerns surrounding homebirth are greater than those of in-hospital deliveries, having a “homebirth in the hospital” is an option many women are seeking. They want the comforts of home while being in the hospital in case of an emergency. Discovering this balance and improving the birth experience for the woman and her family is quickly becoming the goal of many labor and delivery units across the country.

One of the most important criteria for obtaining the desired birth is who the patient hires for her prenatal and delivery care. Obstetricians (OB) are not well known for their hands-off approach to labor and delivery. Christiane Northrup, an Obstetrician, writes in her book Women’s Bodies, Women’s Wisdom, “For centuries, midwives helped mothers through the pregnancy and birthing processes, standing by them with medical and emotional aide. The very word obstetrics is derived from the Latin word stare, which means ‘to stand by’” (Northrup, 1998). A change in the management of labor and delivery occurred. Northrup goes on to say, “Modern obstetrics, however, has changed from a natural, patient ‘standing by’ and allowing the woman’s body to respond naturally into a domineering and often invasive practice” (Northrup, 1998). In this case, seeking the care of a Certified Nurse Midwife who is naturally-minded, hands-off except when necessary, and well educated in childbirth is the first step in having a homebirth in the hospital.

A Certified Nurse Midwife (CNM) is someone who holds degrees and education in both nursing and midwifery and can attend the births of low risk women in the hospital. “The modern midwife’s approach is to be proactive during pregnancy and childbirth. Instead of aggressively treating gestational problems with the latest medications and the most advanced technology after they arise, good midwives work closely with their pregnant clients to ward off problems before they start” (Margulis, 2013). Because of all the unknowns that come along with pregnancy, especially for first time parents, having a midwife who takes more time with her patient explaining what’s normal and what’s not will greatly benefit the parents, minimizing any fears present.

At times, CNMs may deliver babies at home. This is most common in states which have not legalized home births attended by Certified Midwives or Certified Professional Midwives. “Nurse-Midwives practice legally in all 50 U.S. states and the District of Columbia. Certified Professional Midwives are legally authorized to practice in 28 states. Certified Midwives practice legally in only three states” (MANA). The crucial credential missing between these women and the CNM is the nursing degree.

Once the pregnant woman has chosen her desired provider, she should next consider hiring a doula. “Doula is a Greek word, meaning ‘to serve’. A popular interpretation is ‘mothering the mother’. Doulas are not medically trained and do not provide medical advice” (Ross, pp.9). With this definition in mind, the expectant mother can choose a doula to help her while laboring. Often times the doula and the mother’s partner will tag team, taking turns assisting her in changing positions, providing nourishment, and suggesting ideas for continued pain relief. According to DONA International, an organization that trains and certifies doulas all over the world, having a doula present at the labor and birth of a baby has greatly decreased the length of labor and number of interventions, she has helped reduce the need for Pitocin and labor augmentation, as well as the mother’s request for pain medications and cesarean sections (DONA, 2003). “Having doula support gives couples the confidence to stay home for a good part of the woman’s labor and avoid early transfer to hospital” (Ross, 2012). The longer the laboring mom is able to stay home, the more likely she is to have less time spent in the hospital succumbing to unwanted, and often, unnecessary interventions.

The next step to obtaining a homebirth in the hospital is writing a birth plan. This step requires the woman to educate herself on the processes of both her pregnancy and the birth of her baby, usually by taking classes and reading materials on natural childbirth. She and her support person will sit down and discuss their goals for the labor and birth. She will clearly define the types of pain relief, laboring positions, and interventions she’s open to. Having a plan or a list of desires for the birth of her baby also assists the hospital staff in helping her reach those goals. Most people who write a birth plan understand that the health and wellbeing of the mother and baby are of utmost priority. Communicating their desires both verbally and on paper is critical. Knowledge is power and while laboring, the woman may forget what her goals are. A birth plan and her support people will be able to remind her of those goals when all her power is being focused on bringing her baby into the world. If the staff and her partner do not know what she’d like then reaching her goals will be much more challenging.

Taking childbirth classes is just as important as writing the birth plan and, often, classes offer help in writing the birth plan. “The classes provide training for the pregnant woman and her labor coach in breathing and relaxation exercises designed to cope with the pain of childbirth” (Crooks & Baur, 2014). There are many different types of childbirth classes offered and if the mother is seeking a labor and birth that is natural and “home-like”, then she will most likely be taking childbirth classes that cater to those desires. The Bradley Method is a very common child birthing class that people take. A fee is paid and an instructor meets with the couple, usually along with other couples, to discuss the specifics of her pregnancy, labor and birth with a more natural, pain-free type of birth in mind. “The techniques are simple and effective. They are based on information about how the human body works during labor. Couples are taught how they can work with their bodies to reduce pain and make their labors more efficient” (AAHCC, 2015).

Selecting the hospital in which the mother chooses to birth may be limited to the hospital in her area, however, if she is able to find a hospital that is Baby Friendly Accredited, then she is more likely to have many more options for her birth which are routinely offered by the hospital. The mother and her support people should take a tour of the hospital and ask questions. They should find out what the hospital standards are and use that information to balance out their birth plan accordingly. “Baby-Friendly USA, Inc. is the nonprofit national authority for WHO/UNICEF’s Baby-Friendly Hospital Initiative (BFHI). Our Mission is to assess, accredit and designate birthing facilities that meet the BFHI criteria for implementing the Ten Steps to Successful Breastfeeding and follow the International Code of Marketing of Breast-milk Substitutes — providing mothers and babies with the early support needed to achieve successful breastfeeding, an essential foundation for a healthy nation” (BFA, 2015). Initiating skin-to-skin and rooming-in with her baby are essential in allowing mom to bond with and have a successful breastfeeding relationship with her newborn. These small steps are essential in having a homebirth in a hospital. When one births at home, the baby is not taken away from her, she is encouraged to nurse as soon as the baby cues or starts doing the “breast crawl”, and she and her baby sleep in the same room. Those seeking a homebirth in the hospital will likely have these types of things on their birth plan.

Once the birth plan has been defined and the hospital for birth selected, the next step in obtaining a homebirth in the hospital is managing labor pains. Labor often starts off gradually and increases as contractions come closer and closer together. There are three stages to the laboring process. The first stage of labor involves the uterus contracting and the cervix dilating, usually the most painful part of labor. This stage can last several hours, especially for first time mothers. During this first stage of labor is when having a calm, quiet setting for the laboring mother is essential in having a homebirth setting in the hospital. Since this stage can last for a long time, it is important to allow the mother to eat and drink as she wishes while also resting when she is able. Some things that may help her manage pain include massage, a birthing ball to bounce and sit on, having a tub or shower to relax in, low lighting, quite, clustered care from the hospital staff, intermittent fetal monitoring, and the ability to move freely. These are all things she would be doing at home to manage her labor pains. There is no reason any of these things should be restricted in the hospital unless the mother has other risks associated with her pregnancy.

Labor is exhausting and it usually isn’t until transition when the most severe labor pains are present. Transition occurs just before the mother is fully dilated at 10 centimeters. Feelings of wanting to give up and asking for pain medications are common indicators that the mother is in transition and close to the second stage of labor, the pushing stage. During this portion of the labor, it is essential for the mother’s support people to guide her through the pains of contractions as they are likely on top of each other, offering little to no relief. Providing calming voices, massage and allowing her to vocalize as she feels necessary is all a part of labor and having a homebirth in the hospital. It is likely that the nursing staff and the midwife are preparing for the birth by setting up a baby warmer and sterile instruments for after delivery. While this scene is not one you will see at home, it is the part of delivery that the couple should expect from delivering in the hospital.

“Some mothers enter the pushing stage gradually. They feel a lot of rectal pressure at the peak of each contraction. As their bodies dilate the last 2 centimeters or so, this pressure builds until the feelings associated with dilating are taken over by the sensation of pressure and fullness, and you can do nothing else except push” (Drichta & Owen, 2013). The second stage of labor is much faster than the first stage. For some it can take only a few pushes to get her baby out while for others it may take a few hours for the baby’s head to descend past the cervix and birth canal. If the mother has declined all pain medications up until this point, then she should be fully capable of pushing in a position which feels best to her. This includes squatting, hands and knees, and side-laying. All of these positions work with gravity and the shape of the mother’s pelvis to ensure that pushing is effective.

Part of having a homebirth is not being directed or instructed on when to push. Self-directed pushing as the mother feels the urge to do so should be well supported in the hospital. Only if the baby or mother was showing signs of distress would directed pushing or pushing in a certain position be important. The last part of this stage which should be defined in the birth plan would be who is going to catch the baby as she slips into the world. At home, the mother and/or fathers are encouraged to catch their baby. The midwife will assist the head out as it crowns and direct their hands into a position to catch the baby. This option may not always be available in the hospital, depending on their guidelines, however if the desire is there then it should be encouraged.

After the baby has been born, she should be placed directly on her mother’s bare chest. The second stage of labor is now complete. A common practice in home births, which is also increasing in hospital births, is delaying the clamping of the umbilical cord. This is the lifeline between the mother and baby. As the baby takes breaths and begins to cry, the pulsing blood through the umbilical cord from the placenta decreases. Many couples request that the cord is left pulsing for several minutes to allow for the blood from the placenta to be received by the bay. Doing so has many benefits, the greatest of which is a lower risk of having iron deficiency issues in the first six months of life. “Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits, including increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and lower frequency of iron deficiency anemia in term infants” (ACOG, 2014).

The third and final stage of birth is the release and delivery of the placenta from the uterine wall. As soon as the baby has been born, hormones race through the mother’s body, signaling the change. This biological message expels the placenta as its job of nourishing the fetus has come to an end. The delivery of the placenta also signals the uterus to continue to contract and shrink which should, in most healthy cases, stop excessive bleeding. This stage of labor can be handled the same at the hospital as it would at home. The mother may need to give a few small pushes, but abdominal massage and pulling on the cord to get the placenta to come out faster is not necessary. The midwife will inspect the placenta to ensure that all its parts are intact. If the mother happens to retain any part of the placenta, she may experience continued bleeding and clotting issues.

Birth, while not a disease or illness, can come with a host of risks. People who want to give birth in the hospital but also desire home qualities are usually doing so just in case something were to happen in which a fully-staffed medical team would be necessary. Maternal risks include preeclampsia, which is pregnancy-induced hypertension, gestational diabetes, placenta previa, where the placenta covers part or all of the cervix, being Group-B Strep positive, placental abruption, wherein the placenta prematurely detaches from the uterine wall prior to the birth of the baby, infection, and postpartum hemorrhaging. All of these risks also pose different risks to the unborn baby. Fetal-specific risks include a cord prolapse, where the cord exits the birth canal before the head, causing life-threatening pressure to the cord and cutting off blood supply to the baby. Other risks to the newborn are meconium aspiration and shoulder dystocia. For many of these situations, the baby may need to be delivered by cesarean section to ensure the life and safety of both mother and baby. These are also risks which a homebirth midwife is not equipped to handle at home. If any of these things were to arise during a labor at home, immediate transfer to a hospital would be necessary. Something like a placental abruption offers very little in the way of time. It usually occurs quickly and without warning. For this reason, giving birth in the hospital would be safest. Labor and delivery nurses and the extended staff of midwives and obstetricians are trained to identify these kinds of risks quickly.

If a mother has a known risk factor, such as preeclampsia or Group-B Strep (GBS) positive, are risks which can be easily managed in the hospital with medications such as magnesium for the preeclampsia and antibiotics for GBS. While these risk factors exist, it is not out of the question for a mother to be able to still have a homebirth in the hospital. She may require extra attention and monitoring, however, none of this should discourage her from having a natural birth if she so desires. The key is to be open to the necessary interventions that will keep her and her baby healthy and safe. If she lacks an openness to the required protocols of the hospital, she may become disappointed and unhappy with her birthing experience. Should an emergent risk arise during the labor or birth, the mother’s midwife and hospital staff should clearly explain everything that is happening and ensure that she understands the procedures that need to be done are to keep her and her baby safe. Too often staff do not inform their patients well enough about what is happening and this can leave her feeling very confused and hurt.

Having a homebirth in the hospital is possible. Certain steps need to be taken prior to and during the labor to ensure that as many of the mother’s goals are met. She and her support people need to clearly communicate what they would like to see happen and to feel confident in the interventions they may decline unless medically necessary. The expectant mother and her partner need to understand the ins and outs of her pregnancy and labor by taking classes, having a hospital tour and educating themselves so that they are well-prepared for their baby’s impending arrival. Having this knowledge will give them the proper ammunition needed to meet their goals while in the hospital. The mother must be upfront with her midwife about her health and pregnancy history and discuss her options freely. All this and more will help enhance her child birthing experience and goal of having a homebirth in the hospital.

References

Crooks, R., & Baur, K. (2014). Our sexuality (12th ed.). Redwood City, Calif.: Wadsworth

Cenage Learning.

Drichta, J. Owen, J. (2013). The Essential homebirth guide. New York, New York: Gallery

Books.

Margulis, J. (2013). Your baby, your way. New York, New York: Scribner.

Northrup, C. (1998). Women’s bodies, women’s wisdom: Creating physical and emotional health

and healing (Completely rev. and updated. ed.). New York, New York: Bantam Books.

Ross, S. (2012). Doulas: why every pregnant woman deserves one. Summer Hill, Australia:

Rockpool Publishing.

American Academy of Husband Coached Childbirth. (2015) The Bradley method classes.

Retrieved May 3, 2015, from http://www.bradleybirth.com/WhyBradley.aspx

American Congress of Obstetricians and Gynecologists. (2014). Timing of umbilical cord

clamping after birth. Committee opinion No. 543. Retrieved May 3, 2015, from

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-

Obstetric-Practice/Timing-ofUmbilical-Cord-Clamping-After-Birth

Baby-Friendly USA. (2015) Mission and vision. Retrieved May 5, 2015, from

https://www.babyfriendlyusa.org/about-us/about-baby-friendly/mission

DONA International. (2003). Why Use a Doula? Retrieved May 1, 2015, from

http://www.dona.org/mothers/why_use_a_doula.php

Midwives Alliance of North America. Legal Status of US Midwives.  Retrieved May 1, 2015,

from http://mana.org/about-midwives/legal-status-of-us-midwives

Evelyn’s Birth Story

In honor of Evelyn’s 2nd birthday, I am re-posting the story of her birth. I always get so nostalgic around my baby’s births. I relive every minute leading up to their arrival and am filled with so much joy recalling their special day. Evelyn’s birth was incredible. I hope you enjoy reading it as much I enjoy sharing it.

****

  
The first baby I ever caught….

…was my own. This is the birth story of Evelyn Taylor who made her way Earth side on Monday, May 20th at 5:39pm weighing 6 pounds & 14 ounces and stretching out to 18 and 3/4 inches. Her story begins on Sunday, May 19th…

On Sunday morning I woke up feeling tired, which was nothing new, but I could barely keep my eyes open. B headed to work and it was just me and Logan for the day. However, I knew I had to get some help with Logan so I called my parents and they gladly took him for several hours so I could sleep some more. As I was getting Logan ready I noticed contractions coming and going. This was nothing new as I had been in prodormal labor for weeks at this point. Of course I secretly hoped “today is the day” but all the false labor did not have me convinced.

I came home, ate some lunch and slept for a few hours through some mild contractions. Around 1:30 I woke up, feeling a lot more cramps in my low back. Again, I had been feeling these pains on and off for several days, but noticed they started off very close together, 2-3 minutes apart and rather uncomfortable. I updated my parents and B and tried to see if I could get labor going. I was still not sure if this was the real deal, but I figured walking and bouncing on the ball would help if it was.

  
After a few hours, I called B to come home a little early. I was beginning to think this was going to be the night and we had to get some things together. My parents had to drop Logan back off with us for a few hours before we left. I wanted to try and labor at home as long as possible. As of the previous Friday, I was 2cm dilated and 50% effaced with a very posterior cervix. So I labored away, contractions coming a little stronger and still every 2-3 minutes apart. Logan and I walked around our cul de sac as it was a beautiful night. The dogs ran around the circle with us and I knew this would be the last thing I would be doing with Logan before he became a big brother. Somehow, I held my emotions together most of the evening until it was time for us to leave for the hospital.

  
I was bouncing on the ball watching Bruno Mars open up the Billboard Music Awards. I had already called the triage nurse and was instructed it was time to come in. I called the hospital and everyone was ready for us. So I took Logan into my arms and told him his sister was going to be coming today, that he was going to be a big brother. I told him we were going back to Lolly and Pop Pop’s so he could have a sleep over with Pop Pop and then tomorrow, Grandma Mac would come and play with him after school. He seemed to understand everything, repeating what I told him. My eyes filled and I gave him a huge hug and kiss. Logan hates seeing me cry so I choked back the tears and off we went.

  
We dropped Logan off with my dad and picked my mom up. She and B were going to be my birth partners, taking turns helping me through this birthing process. We had a 30 minute drive to the hospital. Contractions stayed regular. Everything everyone else says about labor in a car is true–it sucks!! I could not wait to get to the hospital!

We arrived at the hospital just after 8pm. I was still 2cm and 50% so I got into the tub to see if that would help relax me. It worked! After 2 hours I was nearly 4cm and was admitted. The first attempt to get a hep lock in blew my vein but the 2nd one was done beautifully. The best part was that I did not need to be hooked up to anything. I was drinking plenty of water on my own and it was “just in case” and hospital policy.

I love the midwife, Lani, who was there when I walked in but she was off at 7am Monday morning. At this point, I’m very vague as to the timing of certain checks, but I would guess that between 10pm and 2am we walked the halls, I got back into the tub, and prayed for progress. Labor pains were still manageable but strong enough for me to stop and breathe. I was no longer able to talk through them. Around 5am I was checked again and made a little more progress, nearly 5cm with a bulging bag of waters. Up until this point, though I had been admitted, I had been laboring for over 12 hours and was making very slow progress. Both the nurses and my midwife talked about letting us go home to labor on our own, but I knew that was a bad idea. I knew my anxiety would shoot through the roof. I’d have no idea when it would be time for us to come back and that was another hour round trip in the car going through much harder labor than hours before. So when we found I was 5cm with a bulging bag, we all agreed that breaking my water was the best choice. At this point, I had been awake for over 24 hours and was really starting to feel exhausted.

After my water broke, we kept walking the halls. SIX hours later and I had made NO progress. I was so upset. At this point, I wasn’t going home because my water was broken so we decided that if by 1pm I was still 6cm we would start some pitocin. I labored on some more, contractions getting much stronger. We all really thought this meant I was progressing and baby was coming down more.

  
Around 1:30pm, Cassie, my midwife, came and checked me again. NOTHING. Maybe some more effacement around 75%, so it was time for some pitocin. My body was in labor, but taking it’s sweet time. Problem was I was so terribly tired I could barely keep my eyes open and I needed a break. Pitocin does not offer breaks! As they hooked me up to the pitocin, my nurse started things off nice and slow and I was given some fentenyl to take the edge off and help me rest. I laid in bed for about an hour. Contractions kind of went all over the place for a bit, but once the pitocin was flowing the contractions became really strong and very regular, about 2 minutes apart. Around 4:30pm I started begging for an epidural. My mom kept asking me if I was sure and I kept yelling yes! A true sign of transition. 😉

Some fluids were hooked up and I was given another dose of fentenyl as there was someone in front of me for the epidural. I was starting to lose it. Everything was an absolute blur. I could not move in bed. I just sat up and grabbed both sides of the bed, shaking my legs back and forth during contractions that were now nearly on top of each other. I was breathing hard and fast which made me feel light headed between contractions but I almost think that was a good thing. It was almost euphoric for a few seconds. This is where I realize now that the pains were not going to get any worse. With Logan’s birth, I was saying “no, no, no!” over and over again. It was only moments before Evie was born that I started to say things like “no!” and “where is my effing epidural?!”

My nurse Marilyn was amazing. She was so calm and supportive the entire time I labored. At one point she suggested she better check me because 2nd babies come faster. I was 8cm and fully effaced. She set everything up. Cassie came in to check on me and said she’d be in the OR training but as soon as I needed her she would be there. Moments later the anesthesiologist walked in. I said, “Thank you Jesus!!” I wonder how many women say that to him. 😉 He started to work very quickly. There were no breaks for me anymore and I was certain I was dying. Obviously, I wasn’t…it was just only a few moments before baby would come. He had me sit up and lean over a table. The change in position must have been all baby needed to really come down because I was suddenly pushing and could feel her head right there! The anesthesiologist had placed the cath and administered a small dose, but there was no relief and before I knew it I was screaming that I couldn’t stop pushing. I leaned over, almost on top of all the needles and things needed for the epidural.

Nurses filled the room and Cassie was still not there. Another doctor showed up, ready to deliver the baby and I yelled for someone to go get Cassie (which I know someone already had). She was really the only one I wanted to catch my baby. Then, she was there. She sat on the side of the bed. She made me look at her and she coached me through 3 of the most intense pushes and pain I have ever experienced in my entire life. I even remember yelling “I feel everything!!” and she said that was how it was going to be. As baby crowned she had me breathe her head out. I felt the ring of fire and remember telling myself it was for just a few seconds. Baby’s head would be out and the fire would go away. One more push and baby slid right into my hands. Cassie helped her head out and I reached down and caught my baby! I pulled her up onto my chest. She had a short cord so she laid mostly on my stomach. I spread the legs apart, B standing just to my right and together we saw she was a girl! We exclaimed with joy that baby was a girl and we all started to cry and laugh! I knew she was a girl and Logan especially knew he was going to have a sister.

  
Evie was covered in vernix. She had it in her ears and all over her little body. She was slow to pink up so she had some O2 placed over her face. She was so calm, barely cried. We waited for the cord to stop pulsing before B cut it. Evie pinked up quickly and the O2 was removed. She stayed on my chest for an entire hour while I delivered the placenta. I recall thinking, “oh yeah that thing has to come out too…” and it did easily. Cassie fixed a small tear with a few stitches and soon enough I was cleaned up and just enjoying my baby girl. Logan and B’s mom came by. Logan was a little overwhelmed by all the lights and instruments around the room, but he did take a few moments to say hi to me and his new sister. He gave me a “Mama” necklace and Evie a pink monkey. Their visit was short but just what I needed to get through the rest of the night without my first born.

  
It was a few hours before we were moved over to women’s care. I was able to get up and go to the bathroom on my own, something which I had not been able to do for several hours after Logan was born due to the epidural.

Putting this birth into words is hard. Yes, I wrote out as much as I could but to capture how truly incredible it was feels impossible. I’m still in awe that I gave birth naturally, without an epidural and so quickly. We figure my labor was just under 20 hours and less than 5 minutes of pushing. As far as a 2nd birth goes, the only part that seemed typical was how quickly she was born and I am so grateful that when she was ready, she came.

What’s up?

It’s been awhile since I actually wrote something with decent substance and I am not promising that this will have any of that, but I’ll certainly try.

A few weeks ago I floated to another hospital and was able to witness an amazing, unmediated, beautiful birth led by a midwife I had not yet seen deliver a baby. My mind was blown. Mom was trying to push on her side and baby was unhappy. The midwife gently suggested she adjust her positioning and just like that baby was happy again. The mom let her body do all the work. She pushed when she felt like it and rested when she needed to. Then, she realized her body could not stop pushing and less than a minute later the baby’s head was born with a nucal cord x1. A few seconds later baby was out and up on mom’s chest. I took over the camera so dad could cut the cord and I caught it on film for him. Every time I see a birth, my heart literally explodes with joy and excitement. I know birth is not always like that, but it is BECAUSE of births like this that my passion is fueled and I am reminded once more that yes, Sarah, this is where you belong.

My mom is doing ok. She is on a new chemo med that is not nearly as hard on her body. She still gets really tired but has had a lot more energy to spend time with the kids and work in the classroom. This is all so encouraging. Looking back to when this all began on October 24th, it’s hard to believe almost 5 months have passed since the diagnosis.

School is going alright. I don’t feel like this semester is better than last semester, which is strange because the load is not harder. I have been struggling with one of the professors but I *think* we are finally on the same page. I always wish I was doing better grade-wise, which is me just being too hard on myself. I am doing FINE. As and Bs are great! I just want more As than Bs and sometimes it’s just not in the cards. I’m learning not to be so hard on myself, especially with the load I have while in school between work and family.

My son, Logan, turned 5 a month ago. We got him registered and accepted into the school of our choice for kindergarten which is pretty crazy and exciting! Evelyn is a ball of fire as usual. She still doesn’t sleep through the night and is starting to show her girliness more with more diva and sass. You can follow me on instagram if you want more current, daily updates.

Have a great weekend!

Clark’s Birth Story

No better way to kick off new birth stories than to share one from a mom who’s already shared a previous birth story! Heather is a dear friend and recently had her second baby last spring. You can read her first birth story of her daughter Julie HERE. This is an amazing display of natural, hospital birth where mom and dad maintain control, while also allowing their midwife and staff to care for them. Also, this is the definition of a precipitous birth! Heather, you nearly had a baby at home, my love! 😉

***

Clark’s Birth Story

I started losing my plug at 35 weeks and 2 days. That combined with the fact that my first baby arrived at 38 weeks and 2 days had me convinced this one would be early too. I was a little worried because my husband was best man at a wedding in Texas (we live in Colorado) that fell right on my 38 week mark. So, while I was very ready for the baby to come, I was hoping he/she hold out so that Dad could be there too. As it turned out, there was no need to worry.

Despite wind storms, snow storms, and lots of false starts, May 10 came and went. Although I knew it’s not physically possible to be pregnant forever, it was sure starting to feel like I would be! I made my appointments for non-stress tests and ultrasounds and my induction date was set for May 24. My husband and I agreed that we wanted to leave no stone unturned before then in terms of getting things moving without medication. We continued walking everyday, I ramped up squats and started drinking more raspberry leaf tea. I went to the chiropractor and she suggested acupuncture, which we ultimately decided was worth a try.

Monday, May 12, I went to work as usual. As I was expecting to be gone by this point, there wasn’t much for me to do. I tinkered around with some things and then left a little early and headed to the chiropractor for my acupuncture session. I left feeling no different and with a follow up appointment scheduled for the next day. About 4:30 or so on Tuesday morning, I woke up with a useful feeling contraction, but after so many false starts that petered out after an hour or so, I refused to get my hopes up. I went to the bathroom and lie back down knowing that my daughter would be up soon.

Contractions continued, strong enough that I had to concentrate on them, but still nothing I hadn’t felt before.  Like clockwork, my daughter got up at 5 and I went in to get her, thinking I’d let my husband sleep in a bit since I was already up. I had another contraction in the middle of our good morning conversation and I actually had to stop talking and brace myself. That’s when I knew the baby was coming for real. I went in to tell my husband that I was pretty sure it was the day, but I wanted to eat something and see how things played out before we alerted everyone (my in-laws were staying with us to watch our daughter while we were in the hospital). I texted our doula, around 5:30 or 5:45 just to let her know I’d had a few pretty serious contractions and that I was planning to eat breakfast and keep her posted.

My husband made my daughter breakfast and I started making some cream of wheat for myself, but the contractions were strong enough that I really wanted to be in a quiet area so I headed back upstairs. By the time my husband came up with my abandoned cream of wheat, I was starting to need help during my contractions. I had set up the heating pad on my back and was riding through contractions as best as I could on my hands and knees.  My husband called our doula and the midwife’s office a little after 6. The midwife on call asked if we’d like to meet her at the office for a check before going over to the hospital or if we’d like to stay home a bit longer. My husband told her we were going to stay home; I was convinced I wasn’t very far along.

My contractions were strong but coming at very irregular intervals. I’d have a long one and then right after it ended, I’d have a shorter but just as strong piggy back contraction and then get a break (my midwife later told me she believes that this is because the baby was too big for my uterus to tighten all the way around him in a single contraction). My husband suggested that I get into the shower because he needed to load the car and get things ready and he knew from my first labor that I should be able to labor in the shower alone. I turned the hot water all the way up on my back and leaned my head on the cool tile and braced myself on the shower door handle. I was still having strong but irregular contractions when my husband got back. I told him I needed our doula and I couldn’t do it alone anymore. She arrived around 7:20 and I was on my hands and knees laboring in the way that worked best with my first labor. My arms were so tired though, so my doula brought up the exercise ball for me to rest my upper body on. My husband was squeezing my hips during contractions and my doula was rubbing my back and hips and legs between. The between-contraction massaging was so nice, because it kept me in the moment and didn’t let me dwell on the upcoming contraction and get scared. I was still sure I wasn’t far along because of how irregular the contractions were and the fact I had not had any show.

By 8, I was ready to go to the hospital no matter how far along I was because I really wanted to sit in a Jacuzzi bath. My husband called the midwife’s office and told them we were on our way. Meanwhile, I was starting to feel pushy during my contractions and my doula was worried we might have waited too long to leave. I kept repeating that I hadn’t had any show and she said that doesn’t matter. As she and my husband were helping me into the car, she started coaching him on when to pull over if things kept progressing. I knelt in the front seat facing backwards. My husband had kindly put a Tupperware back there in case I got sick. My doula had put a portable heating pad on my back before we left the house. I was still feeling pushy with every contraction and my poor husband was trying to drive as quickly and safely as possible while coaching me to breathe through the contractions and not push.

We arrived at the hospital and my husband asked if I wanted to go through emergency or if I wanted to park and walk and I chose to walk. It felt so good to be outside and the cool morning air gave me a second wind. My doula and my husband walked on either side of me and we made it in without having to deal with any contractions. I wanted to walk up to the labor and delivery floor but my doula talked me into using a wheelchair. I didn’t want to sit, so she helped position me kneeling backwards with my head resting on my husband’s chest. We made it to the hospital room around 9 and they hooked me up to the fetal heart rate monitors while the midwife checked my progress. To my total shock (and relief!), I was already 10 cm dilated. The midwife gave me the ok to push if I wanted to.

I started out on all fours with the back of the bed raised, the same way I pushed with my first. The nurse wanted to give me a hep-lock (which is something we said we were fine with in the birth plan), but in the moment I really didn’t want to have to mess with that. Plus I was holding pillows during contractions and I was paranoid that I wouldn’t be able to do that with a needle (or whatever) in my arm. My husband had to refuse a couple of times because the nurse was harping on the fact that if I needed a blood transfusion, this refusal would cost us precious time. My husband confirmed that that was alright. Meanwhile, pushing was getting me nowhere and the midwife said if I couldn’t make some good progress moving you down with the next few contractions that she wanted to go ahead and break my water. The baby was still at a -1 station and she thought that breaking the water would help move things along. She also suggested waiting to push until the contraction built some momentum so that I’d have that to help me.

After a couple more useless-feeling contractions, Someone (I have no idea who…it might even have been me!) decided it might help to squat and they got me a squat bar and everyone helped me change positions. The midwife said this would be a good time to break my water and stepped away to get her tool—just in time because my water broke on its own just then and would have covered her if she was still in the splash zone! It was like a movie, spurting several feet across the room! The baby didn’t like the new squatting position and both of our oxygen levels were too low for comfort so I got an oxygen mask and LOTS of reminders to breathe deeply between contractions. The baby’s heart rate was still dropping too low during contractions so the birth team helped me to get onto my left side first (no change) and then my right, which the baby seemed to like, but I was convinced would be a terrible position to push in. My birth team helped me to kind of squat on my side though, which seemed to help.

With everyone coaching me, I started to push with everything I had during every contraction. I could finally start to feel the baby sloooowly moving down. For sure it was the hardest thing I’ve done, physically. The baby started crowning a little after 10am and my midwife told me he/she was very big and I’d need to keep pushing hard to get the shoulders and the rest of the body out.  A few more difficult contractions later, my son was born and my husband told me “It’s a boy!”. Everyone in the room marveled at his size as he was moved to my chest. He had some fuzzy hair and very large hands with long fingers and big feet—his footprints were bigger than the box on his chart! My midwife was also was shocked by the size of his placenta. I guess a big boy needs a big support system!

My midwife was concerned that I had a very bad tear, but the doctor that came in to consult deemed it only a 2nd degree, same as with my first despite 2 lbs difference in their sizes. While my midwife stitched me up, I held my son (he was completely uninterested in breastfeeding right away) and chatted with my husband and doula, and the nurses. My doula helped me order some food and brought some for my husband and then left to attend another birth and said she’d be back later to check on us. I got a shot of pitocin and cytotec to help shrink my uterus and curb the bleeding and had some blood drawn to determine my iron levels while my son was weighed and measured. He came in at 9 lbs, 7 oz, and 21.5”. I couldn’t believe it! All of the nurses we had that day kept commenting on it too. Around noon we finally moved to the maternity ward and enjoyed our first few quiet moments of the day.

Calling all BIRTH stories!!

It has been FOREVER since I posted a few birth stories and we need to change that. I will post ANY kind of birth story. Home, hospital, c-section, loss…every birth story matters. YOUR birth story matters, no matter what. Please consider sharing your story, with or without pictures. As long or as short as you want. Leave a comment here or send me an email. Thanks!!

midwife101blog@ gmail . com

In the mean time, check out my kids’ birth stories by following their links above. Enjoy!

Sarah

On Home Birth vs Hospital Birth (for me)

(A personal post…)

I have so much on my mind. Hop on the coaster with me as I write out these jumbled thoughts.

I am so inspired by other midwives. I read a great interview with Rachel Reed, a midwife in Aussie on the Sunshine Coast. She is a home birth midwife and one of the few in the entire country. She says,

Maternity care needs to focus on what women want and on evidence based, humane practice. Midwives need to embrace their core purpose which is to be ‘with woman’ and stop trying to gain status through aligning themselves with medicine. We need to rebuild our own body of knowledge based on women’s experiences, and underpinned by a deep understanding of birth physiology.

What a powerful statement! Being a midwife is not about the other midwives you meet or work with, it’s about being with women in their most vulnerable, precarious state. I feel so blessed that I am on this road and will join midwives like herself whom I can channel positive energy and encouragement from. I know of several midwives who work in our hospital but I have not had a chance to get to know them or ask questions.

On that note, we (as in my husband and I) are planning on our 2nd baby. (Happy Dance!) This means I have been researching everything I can on the one and only birth center in Colorado, Mountain Midwifery, and home birth midwives in my area. First off, I did not realize that home birth midwives in Colorado are ALL CPMs, Certified Professional Midwives. This took me back for a moment. I respect the knowledge and education any midwife gains, whether she is a CPM or CNM. However, I have never been comfortable with the idea of a CPM at my birth. Go ahead, scold me for being judgmental. I only judged for a moment until I read the true definition of a CPM and what the Colorado requirements are for one to practice home birth in Colorado:

Registered Midwives are professionals trained exclusively in midwifery through academics and apprenticeship, by direct-entry. These “Direct-Entry Midwives” are licensed to practice homebirth in Colorado. Only Registered Midwives are specifically trained to serve the homebirth population in Colorado. The majority of midwives worldwide are direct-entry midwives.

As you can tell, I am still learning. There is such a huge scope for midwives and as I’ve said before, I am not planning on becoming a home birth midwife, though I support home births and the midwives who attend them 100%. I felt better after I read on and more comfortable and began a search into the CPMs in my area as well.

During my search, I called Mountain Midwifery to get some clarity on their financial information. I also called my insurance company beforehand to find out what they covered. My insurance is through the hospital and is self-funded, meaning that the rules do not apply to someone like myself wanting a birth in a birth center. The law states that a fully-funded insurer cannot deny my right or coverage to birth in a birth center. That being said, my insurance does not cover a home birth or birth at the center. :::headdesk::: I was defeated! But I called anyway to find out exactly how much we’d be paying as a self-pay patient in the center: $4500, give or take a bit. WOWOWOO!! Really?! Defeated again.

I knew then that the birth center was out of the question and my emotions toyed with me as I battled over the “this is worth it” and “how will I get the birth I want in a hospital” thoughts. I also knew that home birth midwives charge $1000-3000. They do accept insurances and most reimburse you but mine won’t. So I’m screwed there too. I wish I could say we’d save up and make it work, but we have other obligations and needs for our families. Today, I have been letting my mind accept that our birth will take place at the hospital, the same we delivered in the first time. This is not a bad thing. We had a great experience and the NICU is incredible. We never imagined we’d need it but we did and walked away with nothing but good thoughts.

The trouble I’m having is what I know now about the inner workings of the nurses and what our hospital requires. I have seen the looks on the faces, the eye rolls, and general annoyance they have with certain patients, especially those who are choosing to birth outside of their (the nurses/hospital) idea of what birth should be like. I get that. Some of these nurses have been in L&D for years and have a very set way and frame of mind as to what labor and birth should look like. However, I really believe in continuing education, especially in the birthing world and wish the newer knowledge surrounding birth was more accepted. For example, the fact that ALL low risk births in England are attended by a midwife and only if a complication arises and a patient is high risk does an OB get involved. I really believe in revolutionizing this part of our hospitals thinking but have no idea how or when the change will come.

Until then, I will, both as a patient and student, continue to educate myself on my birth choices and what I want for our next hospital birth.  I’m just glad to say that my reasoning for not having a home birth is no longer based on the fear of something bad happening (as it was for a long time). Thank you to many birth warriors out there for curbing that fear and allowing me to become more in touch with what my body is capable of.

Happy Hump Day!