birth

I am moving into my last week of Maternal-Newborn and feelings are bittersweet. I want so badly to stay right here in my comfort zone of birth, babies and mothers; however I must move forward into new classes to finish out my degree. I’m down to 8 months of school left and I will officially be a RN, BSN! Wow. That is so crazy to write! I have been on this road now for FIVE years. YES, 5! I was pregnant with my daughter when I started my pre-recs and the month I graduate she will turn 5.

The beginning of August was rough. I was so excited to have started clinicals in the hospital! But I had come down with a nasty virus that turned into a sinus infection and I missed two weeks of school and clinical! My heart was broken! I was miserable and also, I turned 33 so I spent my birthday not feeling so hot. A few days before my birthday, B took me to a tattoo shop and I got a tattoo I have been wanting for years! I had not decided where I wanted it until just a few days prior and I can honestly say I am so happy with it! What did I get?!?

OXYTOCIN!

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Everyone asks if it hurt-it was uncomfortable but actually painful? Not really. This is on the inside of my right bicep. The line work is incredible!

This special tattoo could have not come at a more perfect time. I was in my Maternal-Newborn class and gearing up to help women labor and give birth! After I was cleared to return to clinical from being sick, I spent 2 days in L&D and saw two beautiful births. One cesarean and one vaginal (no epidural-just some IV fentanyl). Both births made me feel like I was home, like I was right where I needed to be. My heart was full, my mind was growing with knowledge and happiness. It was wonderful.

I have 4 more days in clinical and then this class is officially over. I head into Population health and then Peds for this fall semester.

Thanks for checking in and sticking around with me! Two more semesters and I’m done! 😉

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the next few weeks

It’s September! And guess what? I am NOT crazy about fall. Not yet, anyway. I love the weather and fallish things that happen this time of year, but I am not ready for it. I LOVE summertime. I love the heat and the shorts and the flip flops. I love seeing my kids run through the sprinkler in the front yard and ride their bikes around the circle. I love sitting on the back patio with a beer at 9 pm while the temp is still 80*. And since it’s still over 90* here, I am not at all ready for wintertime. I am also not a huge fan of pumpkin spiced things. I like it, for a moment, but I don’t obsess over it like a lot of people seem to do. I think other hesitations in welcoming fall comes with the fact that I am {thisclose} to applying for nursing school. It is finally here and I’m kinda freaking out! I’m excited and nervous. I’ve been working towards this goal for a little over 3 years now and it’s finally happening! I have become quite comfortable taking my prerec classes online and managing my school life from a distance, but come April, I will be in class at least once a week applying my skills and becoming a nurse. WHAT?! There is also a tiny part of me that wonders, “WHAT IF I don’t get in?” For most reading this, I’m sure you’re shaking your head at me. I am a great student. I have worked really hard so I know that the chances of me not getting accepted in the program are very small compared to those in which I would get in. But it’s a hard, uneasy, exciting balance.

Over the next few weeks, I will be taking the TEAs test, a standardized entrance exam, attending a pre-BSN meeting, and starting my Statistics class. September, I’m sure, will fly by so I am willing to welcome fall once the temps have cooled down and these three school items are checked off my list.

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!

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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

semester is over!

I am so happy to announce that the spring semester is over! I have to admit that this was not the easiest, but it did end up well and I learned a lot. My final grade in Human Sexuality was an A and in A&P II was a B…I am super happy with both grades! I feel so relieved, especially getting everything done and finding the time for classes between work and personal life.

I will be posting a pretty awesome research paper that I wrote for my Human Sexuality class on how to have a home birth in a hospital. Maybe even later today! While I had a lot of technical errors (it’s been SEVEN years since I last wrote a research paper!!), I feel really good about the content and that is what matters.

Have a lovely Hump Day!

~ Sarah

Spring semester is here!

I am officially up and running in two new classes this semester. Human Sexuality and Anatomy and Physiology II, both of which are online, have started out smoothly.

In other news…my mom is doing great with chemo. It’s certainly not fun and sucking every ounce of energy out of her, but I am so glad to hear that she is still working when she’s able and generally doing alright.

Lastly, I got my first ever schlac mani the other day and I love it! I probably will never go without one now! lol

Happy Thursday all!

new year, now what?

I have to admit that I am not all puppies and rainbows about a new year right now. I feel like the last few months have been so taxing that I haven’t even had time to think about all the great things I know that 2015 will bring me. This month, even while off school for a few more weeks, will be busy. I am preparing to take the HESI A2 entrance exam. I am hoping to take that in a week or so. It’s a big deal because if you don’t get 75 or better you can only take it once a year and that means no nursing school. I am sure that won’t happen. I am doing the practice tests and have a study guide. I have strong and weak areas to work on.

I am also getting everything else together that I need to apply for nursing school. This includes transcripts, background check, and more. I have nothing but positive happy nervous energy surrounding this.

Last week I had my first mammogram. I am to have a mammo every year now, followed by an MRI 6 months after the mammo. This means I will now be screened every 6 months for breast cancer for the rest of my life. This is well worth it to hopefully prevent and/or catch anything that may appear super early. I have a small, pebble-sized lump that is being ultra-sounded next week. It is not concerning. I have had fibroadenomas (benign lump) before. Then again, so had my mom. We have fibrous breasts. Screening is critical. I did do the BRCA 1 and 2 screening and it came back negative. However, my lifetime risk is 25.4% of getting breast cancer, hence the screenings. This is the first time in my life I have ever been considered high risk for anything. What a trip.

And lastly, as per tradition, I ought to list a few goals I am happily looking forward to this year:

  • Getting into nursing school
  • Taking a human sexuality class- I never have and am sure it will be fun and interesting
  • Seeing my son start kindergarten
  • Get some home improvement projects done like painting and new fixtures (HA! In my dreams!!)
  • Pay off all medical debt
  • Pay off all cc debt
  • Take a family vacation
  • Read something (anything!) for fun
  • unplug more from social media and TV
  • Start a weekly family game night
  • See my mom complete treatment and be cancer free (really, the ONLY thing I could hope for)
  • START nursing school

See? Not too much to ask for. I will say that while goals are great, I have learned over the last few months that sometimes it is better to just take each day one at a time. I love looking forward to things, but sometimes life needs us to slow down and if I have learned anything from my mom having breast cancer and my best friend dying, it’s to slow down and love and enjoy the day we have right now, right this second. Happy New Years everyone.

prerecs are done!

Last week I received my final grades for Microbiology and A&P part 1…A in Micro and B in A&P!! Considering that the last half of the semester was quite hellish in my personal life, I am very happy. I am so grateful for online schooling! I could not have done any of this without the option. I was very nervous at first to attempt not one but two labs online again, considering that my first attempt didn’t work out well. This semester was actually great. I enjoyed both classes. I felt like it was the first time in all my prerec classes that I was able to apply what I was learning to real life. Next semester I will take A&P part 2 and Human Sexuality, both online again. I am grateful for a break right now. I am going to be studying for the HESI placement test during this break but I’m not hitting it too hard, not yet anyway. My brain feel so fried both from school and emotionally.

Last week, my childhood best friend passed away. It was so unexpected and tragic. My heart cannot take anymore loss or bad news. I work Christmas Day so we are celebrating on Christmas Eve, a day which I am really looking forward to celebrating with family…

Merry Christmas everyone. I’m hoping to post a “year in review” soon.