My husband and I started trying to get pregnant in March of 2009. The first few months were unsuccessful, however being an A-type person, I started reading up on pregnancy/delivery even though I wasn't pregnant yet. Before doing this reading, I always just thought I would get pregnant, go to an OB-GYN and have my baby in the hospital with a heavy dose of pain meds. Once I started researching my mind changed completely! I began to form a strong opinion in the complete opposite end of the spectrum. I believe doctors have over-complicated the beauty of childbirth. Afterall, for centuries women were having babies without drugs, and they continued to have more than one so it had to be somewhat tolerable. Also, being a Christian, I began to realize God created my body to handle childbirth without any assistance and that He wouldn't give me any burden I couldn't handle.
In late July we discovered we were pregnant! I liked the idea of a midwife, but I had no idea where I would begin to look for one. Anxious and eager to see someone I ended up going to an OB-GYN office. From the initial visit I could tell they were not 100% behind me doing an all natural childbirth. When I asked what the practice's c-section rate was they said 25%! That was a little too high for my comfort. I decided I'd relax a bit, and take the time to find an office that had midwives. A girl at church recommended Bethany Women' s Center, so I made an appointment---the smartest move I made while pregnant!
My pregnancy, fortunately, did not have many complications nor did I really get seriously uncomfortable. The only hold-up I ran in to was my due date rolled around and still no baby! I tried everything--and I mean EVERYTHING- to spur labor: sex, walking everyday, spicy food, pineapple, massages, pedicures, etc. I went to 42 weeks, and my baby was still not coming on her own. Thoughts of wanting to be induced definitely filled my head, but my husband kept reminding me that the baby would come when ready, and induction would interfere with my plans for a natural childbirth. The midwives worked with me to get the baby to come out, using the most non-invasive plan as possible.
I ended up having a foley catheter put in and was sent home overnight. The idea was the catheter would help dialate me, and labor would start on it's own. The next morning I woke up, and the catheter was still in me and no contractions. We were told to come to the hospital since i was so late. When I got there at 8 am, I walked for an hour before the catheter fell out, but still no real contractions. They sent me walking some more, still nothing. Finally at noon they broke my water, and I had made it to 4cm. I began to feel tiny contractions, as I continued to walk the hospital hallways. Around 4pm I began to feel real pain. I was still walking which helped. But I was devastated when at 7pm, I was only 4.5 cm---I had only dialated half a cm!!! Diane, my midwife, assured me that I was still making progress; it was ok. From 7 pm til 5 am I was having strong contractions every couple minutes. At around midnight they checked me again and I was at 6cm. It was good I was making progress, but I felt like it was going so slow. I was getting very tired and was starting to doubt whether I could do it. I'd been awake for 24 hours and was losing energy fast--I just kept praying that when they checked me again I would be close to 10cm. When they checked me around 5:30 I was relieved to hear I was at 9.5 cms. I knew I could make it.
From there it all went super fast. Within a few minutes I was ready to start pushing. Diane told me the harder I pushed the faster it would go, so I just pushed with all my strength. Diane did an amazing job helping me push effectively. I know talking to friends who had drs. deliver their babies they felt like they didn't know how to push. I have no idea where the energy came from, but I was able to harness it and push her out. THe pushing was definitely the hardest part but also the best, because I knew I was that much closer. An hour and a half later I had a beautiful baby girl lying on my chest. I know every mom thinks her baby is perfect, but Madeline really was so beautiful (some newborns are kinda weird looking)---those extra couple weeks really paid off!! It was one of the most amazing experiences, and I am so proud of myself and thankful to God, my husband, the nurses, and my midwife, Diane, for helping me get through it. I'm not ready to do it again any time soon, but I know I*'ll be ready/capable. And the amazing part is you really do forget the pain you go through.
Showing posts with label midwife. Show all posts
Showing posts with label midwife. Show all posts
Friday, June 11, 2010
Wednesday, February 17, 2010
Guest Post: Victoria's Birth
From Katie DiBeneddeto's Journal
Monday October 19th 2009
This morning I met Victoria & Tyner at Baptist for Victoria's induction. We got settled into a room and then a nurse came in to do her IV, which sucked because the nurse couldn't do it. Victoria said this always happens though and they always end up having to get the head nurse to come in. Victoria did appreciate though that the nurse quickly realized she couldn't do it and had no problem bringing in someone else. I felt bad for her though because her poor arm was bruised from the couple sticks that didn't work out. Poor thing! A super sweet older nurse was sent in, and Tiffany! I just love Tiffany. She just has such great energy. This was about noon and Tiffany had office hours from 1 to 5 so I guess she was just stopping by before she had to head over and see other moms. The nurse that was brought in was totally rockin and got the IV in on her first try. I told Victoria that next time she should just straight up say "Look honey, I'm sorry, but I know you're not going to be able to get this IV in. Please just skip even trying, get over yourself and bring in your star nurse ASAP". So anyway, once they got the IV in they started a bag of fluid. Pitocin was started a little after 1.
She managed to stay comfortable for the first few increases and then they just started getting stronger and more regular, but she never lost control. I really admired that about her the whole time. Around 2 o clock or so her in laws came for a visit. They were a super sweet couple - they're in from Corvallis, Oregon. They were very encouraging and didn't really intrude at all. Although they did start sort of obsession over the monitor. I know it's hard for people not to do that, but it's still one of my peeves. I always encourage people to look at the mom - that's your best indicator of what's going on. Plus it messes with your head - like a placebo pill or something - "Oh that was a big number (on the contraction monitor), that must have hurt!" and I'm like...."Well look at her face! She's doing just fine". I guess people just take the monitors so literally sometimes. I guess Tyner was motioning or making faces at Victoria or something to see if she wanted his parents to leave, but she wasn't getting it. But Tyner just said to his parents "So, thanks for visiting..." and then took the hint and left. How refreshing!
Then she wanted to eat lunch and of course at first the nurse said no, but then said she'd ask Tiffany and of course Tiffany said yes - it was so early and she could eat whatever she wanted. So she did. We ordered lunch and it was decent for hospital food. We asked a couple of different people for birth balls and Tyner said he never knew whether or not to keep asking. I said I usually just kept asking until I get it. You never know how many patients they have. Once we got it Victoria wanted to get on it just to practice and get the feel for it before things really got intense. She got on and really liked it. We took turns rubbing her back. It was a really nice time too - I got to hear all about how they met and how he proposed and everything. It was so cute to hear them share all of their stories and I'm sure it was a nice distraction for Victoria. They are a really sweet couple. And he was just the best husband (soon to be anyway...) that I had ever seen. So much non verbal communication. She had to use the bathroom a couple of times and one of the times she had a very intense contraction - being on the toilet was not comfortable at all for her.
Tiffany came back around 5:30 and checked her and she was still a 2. Not that that's bad, but I felt so bad for her. I know she was hoping to have been farther along and I knew she was running out of steam. I kept reminding her that her body was doing so much work that couldn't be measured just by checking her cervix. She was also incredibly congested. It took forever to get sudafed. Our nurse was totally out of it. Then Tiffany went to have dinner and said she'd be back later. Victoria ordered some dinner and Tyner went across the street to get some. I stayed with Victoria. She was back on the ball and I was behind her rubbing her lower back. Her dinner came and she sat up in bed and ate it and had a couple of hard contractions during. She is such a friggin trooper though. Then it was shift change and guess who came in? Rian!! I was psyched! And she remembered me too. She is so great. And she got us sudafed in like 15 minutes. She is so incredible awesome.
Soon after my rice sock became Victoria's best friend. I kept running out to heat it up and then Tyner and I took turns putting pressure on her hip while she was laying on her side. Tyner was so fantastic. I've never seen a sweeter partner. He was perfect. They are so good together. She decided to get some stadol because things were just getting to be too much. The nurse started her out real slow and said she'd give her another dose if she wanted it later. Victoria was hilarious after that. It was like she was drunk. Tyner and I were going to sort of nap, but Victoria was like "I'm being so funny right now and you guys are wasting it napping". She is hilarious. Then she said it didn't make the pain go away, it just made it seem farther away. She said it was like her pain was wrapped up like a present. It was in really pretty paper so that's what made her want to open it, but then she would open it and it would be painful and she would tell it to go away. But then the next one would come and it would be wrapped in pretty paper and the whole cycle started over again. It was hilarious, we were all dying with laughter. She told everyone who came in and I think Tyner even got it on video.
Then she got an epidural a bit later. She was in a lot of pain. It's always hard to watch when it gets to that point. But we talked about it a lot and it was what she really wanted, it wasn't like a spur of the moment for no good reason decision. And she had been at it for so long, she was just out of juice. Anybody would be. The anesthesiologist said I'd be trapped back there (in view of the epidural insertion) and Tiffany said it was ok, I was cool. She's so funny. And it was actually fun to watch from that angle. It's so scary though! I can't believe women so readily do it. After that it took a bit for it to kick in, but she was ok. Then Tyner and I napped on and off after she got comfortable.
We woke up a bit later and then all of the sudden there were a bunch of people in the room. That is never good. Apparently the heart rate was dipping and everyone was getting scared. Then Tiffany said they had to do a c section. Victoria was freaking out - I felt so bad for her. She had to sign all these consent forms really fast. It was a horrible situation. But I totally trust Tiffany so I wasn't questioning the c section - that's a really nice feeling. I know Victoria and Tyner did too. I helped Tyner get suited up and then I grabbed their cameras just in case. I asked Tiff, but she said I wouldn't be allowed in. I followed them anyway. As we were walking out I told Tyner I couldn't come in, but I'd be right outside if they needed anything. They wheeled her in and both Tyner and I had to wait outside for the first little bit. There was one chair and Tyner sat in it. I came and stood next to him and asked how he was doing. He just sort of reached out for me so I moved closer to him and held his head against my chest. He wrapped his arms around my waist and I was just overwhelmed. He was so scared and so vulnerable and it was so sweet the way he had just reached out. It took everything in me not to cry. I just held his head really tight and told him everything would be ok and that I knew that waiting was the hardest part. And I just stood there with him. And we waited. Then Tiffany came out and said the heart rate was steadying so they were just going to observe her for a minute. Then they brought her back into the room! I was soooooo relieved. Tyner went over and kissed her. She was shaking though. i can't imagine how scared she must've been. Tiffany siad it just sucks because in a home birth that would have just been no big deal and may have even gone undetected, which isn't a bad thing because variations in heartrate are normal - but in a hospital, where there's huge accountability you can't ignore a heart rate abnormality because of the off chance of something bad actually happening and then you've got record of a dip in the heart rate and no one did anything. It just sucks. After things calmed down we all dozed again.
Then we woke up and she was 10 and it was time to push. It was about 5'o clock in the morning at this point. They got the squat bar and she used that for a bit. Tiffany was at the edge of the bed and Rian and Tyner were helping her hold her legs. They had to give her oxygen at one point just because she had been pushing and was so out of breath. I was trying to stay coordinated with the camera and the video camera at the same time. She was a great pusher and he came out in no time though. It was amazing. I gave Tyner a big hug and put my hand on Victoria's forehead. He was born at 6:05am Tuesday, October 20th. It was amazing. This will never get old. He was such a sweetheart too. And they didn't go out and tell anyone for a while. It was just the three of them for the first hour and they never took Oliver away. It was fantastic.
After a little while they took him to the warmer to get him cleaned up a bit. Then Jesse came in - Victoria's 12 year old son. That was really sweet. Then they invited the grandparents in. I ordered them breakfast. The grandparents didn't stay for too long which was nice. A new nurse came in though and she was not as cool (but no one is as great as Rian). This nurse helped her breastfeed, which is always hard to watch. I wish people didn't make such a big deal out of it. Jesus, he's been out an hour. He's not going to starve himself. Once they were settled I said my goodbye's and headed home. I never even went to sleep. I was too psyched. What a great birth!
Monday October 19th 2009
This morning I met Victoria & Tyner at Baptist for Victoria's induction. We got settled into a room and then a nurse came in to do her IV, which sucked because the nurse couldn't do it. Victoria said this always happens though and they always end up having to get the head nurse to come in. Victoria did appreciate though that the nurse quickly realized she couldn't do it and had no problem bringing in someone else. I felt bad for her though because her poor arm was bruised from the couple sticks that didn't work out. Poor thing! A super sweet older nurse was sent in, and Tiffany! I just love Tiffany. She just has such great energy. This was about noon and Tiffany had office hours from 1 to 5 so I guess she was just stopping by before she had to head over and see other moms. The nurse that was brought in was totally rockin and got the IV in on her first try. I told Victoria that next time she should just straight up say "Look honey, I'm sorry, but I know you're not going to be able to get this IV in. Please just skip even trying, get over yourself and bring in your star nurse ASAP". So anyway, once they got the IV in they started a bag of fluid. Pitocin was started a little after 1.
She managed to stay comfortable for the first few increases and then they just started getting stronger and more regular, but she never lost control. I really admired that about her the whole time. Around 2 o clock or so her in laws came for a visit. They were a super sweet couple - they're in from Corvallis, Oregon. They were very encouraging and didn't really intrude at all. Although they did start sort of obsession over the monitor. I know it's hard for people not to do that, but it's still one of my peeves. I always encourage people to look at the mom - that's your best indicator of what's going on. Plus it messes with your head - like a placebo pill or something - "Oh that was a big number (on the contraction monitor), that must have hurt!" and I'm like...."Well look at her face! She's doing just fine". I guess people just take the monitors so literally sometimes. I guess Tyner was motioning or making faces at Victoria or something to see if she wanted his parents to leave, but she wasn't getting it. But Tyner just said to his parents "So, thanks for visiting..." and then took the hint and left. How refreshing!
Then she wanted to eat lunch and of course at first the nurse said no, but then said she'd ask Tiffany and of course Tiffany said yes - it was so early and she could eat whatever she wanted. So she did. We ordered lunch and it was decent for hospital food. We asked a couple of different people for birth balls and Tyner said he never knew whether or not to keep asking. I said I usually just kept asking until I get it. You never know how many patients they have. Once we got it Victoria wanted to get on it just to practice and get the feel for it before things really got intense. She got on and really liked it. We took turns rubbing her back. It was a really nice time too - I got to hear all about how they met and how he proposed and everything. It was so cute to hear them share all of their stories and I'm sure it was a nice distraction for Victoria. They are a really sweet couple. And he was just the best husband (soon to be anyway...) that I had ever seen. So much non verbal communication. She had to use the bathroom a couple of times and one of the times she had a very intense contraction - being on the toilet was not comfortable at all for her.
Tiffany came back around 5:30 and checked her and she was still a 2. Not that that's bad, but I felt so bad for her. I know she was hoping to have been farther along and I knew she was running out of steam. I kept reminding her that her body was doing so much work that couldn't be measured just by checking her cervix. She was also incredibly congested. It took forever to get sudafed. Our nurse was totally out of it. Then Tiffany went to have dinner and said she'd be back later. Victoria ordered some dinner and Tyner went across the street to get some. I stayed with Victoria. She was back on the ball and I was behind her rubbing her lower back. Her dinner came and she sat up in bed and ate it and had a couple of hard contractions during. She is such a friggin trooper though. Then it was shift change and guess who came in? Rian!! I was psyched! And she remembered me too. She is so great. And she got us sudafed in like 15 minutes. She is so incredible awesome.
Soon after my rice sock became Victoria's best friend. I kept running out to heat it up and then Tyner and I took turns putting pressure on her hip while she was laying on her side. Tyner was so fantastic. I've never seen a sweeter partner. He was perfect. They are so good together. She decided to get some stadol because things were just getting to be too much. The nurse started her out real slow and said she'd give her another dose if she wanted it later. Victoria was hilarious after that. It was like she was drunk. Tyner and I were going to sort of nap, but Victoria was like "I'm being so funny right now and you guys are wasting it napping". She is hilarious. Then she said it didn't make the pain go away, it just made it seem farther away. She said it was like her pain was wrapped up like a present. It was in really pretty paper so that's what made her want to open it, but then she would open it and it would be painful and she would tell it to go away. But then the next one would come and it would be wrapped in pretty paper and the whole cycle started over again. It was hilarious, we were all dying with laughter. She told everyone who came in and I think Tyner even got it on video.
Then she got an epidural a bit later. She was in a lot of pain. It's always hard to watch when it gets to that point. But we talked about it a lot and it was what she really wanted, it wasn't like a spur of the moment for no good reason decision. And she had been at it for so long, she was just out of juice. Anybody would be. The anesthesiologist said I'd be trapped back there (in view of the epidural insertion) and Tiffany said it was ok, I was cool. She's so funny. And it was actually fun to watch from that angle. It's so scary though! I can't believe women so readily do it. After that it took a bit for it to kick in, but she was ok. Then Tyner and I napped on and off after she got comfortable.
We woke up a bit later and then all of the sudden there were a bunch of people in the room. That is never good. Apparently the heart rate was dipping and everyone was getting scared. Then Tiffany said they had to do a c section. Victoria was freaking out - I felt so bad for her. She had to sign all these consent forms really fast. It was a horrible situation. But I totally trust Tiffany so I wasn't questioning the c section - that's a really nice feeling. I know Victoria and Tyner did too. I helped Tyner get suited up and then I grabbed their cameras just in case. I asked Tiff, but she said I wouldn't be allowed in. I followed them anyway. As we were walking out I told Tyner I couldn't come in, but I'd be right outside if they needed anything. They wheeled her in and both Tyner and I had to wait outside for the first little bit. There was one chair and Tyner sat in it. I came and stood next to him and asked how he was doing. He just sort of reached out for me so I moved closer to him and held his head against my chest. He wrapped his arms around my waist and I was just overwhelmed. He was so scared and so vulnerable and it was so sweet the way he had just reached out. It took everything in me not to cry. I just held his head really tight and told him everything would be ok and that I knew that waiting was the hardest part. And I just stood there with him. And we waited. Then Tiffany came out and said the heart rate was steadying so they were just going to observe her for a minute. Then they brought her back into the room! I was soooooo relieved. Tyner went over and kissed her. She was shaking though. i can't imagine how scared she must've been. Tiffany siad it just sucks because in a home birth that would have just been no big deal and may have even gone undetected, which isn't a bad thing because variations in heartrate are normal - but in a hospital, where there's huge accountability you can't ignore a heart rate abnormality because of the off chance of something bad actually happening and then you've got record of a dip in the heart rate and no one did anything. It just sucks. After things calmed down we all dozed again.
Then we woke up and she was 10 and it was time to push. It was about 5'o clock in the morning at this point. They got the squat bar and she used that for a bit. Tiffany was at the edge of the bed and Rian and Tyner were helping her hold her legs. They had to give her oxygen at one point just because she had been pushing and was so out of breath. I was trying to stay coordinated with the camera and the video camera at the same time. She was a great pusher and he came out in no time though. It was amazing. I gave Tyner a big hug and put my hand on Victoria's forehead. He was born at 6:05am Tuesday, October 20th. It was amazing. This will never get old. He was such a sweetheart too. And they didn't go out and tell anyone for a while. It was just the three of them for the first hour and they never took Oliver away. It was fantastic.
After a little while they took him to the warmer to get him cleaned up a bit. Then Jesse came in - Victoria's 12 year old son. That was really sweet. Then they invited the grandparents in. I ordered them breakfast. The grandparents didn't stay for too long which was nice. A new nurse came in though and she was not as cool (but no one is as great as Rian). This nurse helped her breastfeed, which is always hard to watch. I wish people didn't make such a big deal out of it. Jesus, he's been out an hour. He's not going to starve himself. Once they were settled I said my goodbye's and headed home. I never even went to sleep. I was too psyched. What a great birth!
Thursday, February 11, 2010
E's Birth Story
I always encourage women to write their birth stories, whether they have them posted here or not. Having a written account of your birth story is such a nice keepsake for years later when details have become fuzzy. I think it's also a nice addition to a baby book. Someday this child will grow up and may be curious about how they arrived in this world. I regret not having written any of my births up - so many little details are lost to me now. And my husband, well, is useless at that sort of thing :p
E was coming in for induction due to having cholestasis (a condition that carries with it a very high risk of stillbirth after 38 weeks gestation). E was actually 38.6 weeks and this would be her fourth child. She had epidurals with the first three and was hoping to have a natural childbirth this time. She was not thrilled about being induced. Fortunately when she arrived that morning and I checked her, she was 3-4/70/-2. So I discussed breaking her water and waiting for labor versus starting pitocin. We both agreed that the ROM (rupture of membranes) was the way to go. I broke her water and sent her off walking.
I left her to her own devices, with instructions to call me when she started getting active. In the meantime I headed off to see postpartum patients and then the office. I checked in by phone a couple times during the afternoon, to be told that she was feeling more contractions and mildly uncomfortable.
I arrived back at the hospital about 5:30pm to find her ordering some dinner. I decided to check her at that point and she was 4/90/-2. I explained that it does take some time for labor to get going after the water breaks. I encouraged her to snack a bit then do some walking. I told her I would go grab some dinner while she did the same.
But then chaos occurred, as it so often does on labor and delivery :) A patient of one of our doctors came up ready to deliver. I was involved with that for about 45 minutes. By the time I finsihed up there, E was getting active. She was no longer interested in eating. The nurse had her get in the tub.
I went to sit with her while she was 'tubbing'. Her husband seemed a little nervous as E was gradually getting more vocal. he sat with other family members in the room. I told E that he was just not used to seeing her like this :) She vocalized her way through each contraction, then rested, even dozing between. At one point she asked me "How will I know it's time?" I told her she would know...her body would just start to push.
Eventually, her husband sat with us in the bathroom. He rubbed her shoulders and poured water on her belly. He seemed to be adjusting to the fact that E's behavior was very normal (I had reassured him several times). He was doing a great job being supportive. At one point she asked if it was too late to get IV pain medicine. I checked her and told her she was 8cms and yes it was too late. She accepted that without any problem.
I encouraged her to change her position in the tub. She moved to her side but after one contraction on her side, she said "The baby is coming! I need to push". We assisted her to the bed. I encouraged her to get in whatever postion she wanted. I re-checked her and she was completely dilated. I told her she could have this baby whenever she was ready.
I had 'warned' her about the ring of fire previously but she was still caught off guard by it I think. She held back a little but then just gathered her strength and pushed her baby right out. We had a bit of a mild shoulder getting stuck, but was quickly relieved and both mom and baby were doing wonderfully.
E was coming in for induction due to having cholestasis (a condition that carries with it a very high risk of stillbirth after 38 weeks gestation). E was actually 38.6 weeks and this would be her fourth child. She had epidurals with the first three and was hoping to have a natural childbirth this time. She was not thrilled about being induced. Fortunately when she arrived that morning and I checked her, she was 3-4/70/-2. So I discussed breaking her water and waiting for labor versus starting pitocin. We both agreed that the ROM (rupture of membranes) was the way to go. I broke her water and sent her off walking.
I left her to her own devices, with instructions to call me when she started getting active. In the meantime I headed off to see postpartum patients and then the office. I checked in by phone a couple times during the afternoon, to be told that she was feeling more contractions and mildly uncomfortable.
I arrived back at the hospital about 5:30pm to find her ordering some dinner. I decided to check her at that point and she was 4/90/-2. I explained that it does take some time for labor to get going after the water breaks. I encouraged her to snack a bit then do some walking. I told her I would go grab some dinner while she did the same.
But then chaos occurred, as it so often does on labor and delivery :) A patient of one of our doctors came up ready to deliver. I was involved with that for about 45 minutes. By the time I finsihed up there, E was getting active. She was no longer interested in eating. The nurse had her get in the tub.
I went to sit with her while she was 'tubbing'. Her husband seemed a little nervous as E was gradually getting more vocal. he sat with other family members in the room. I told E that he was just not used to seeing her like this :) She vocalized her way through each contraction, then rested, even dozing between. At one point she asked me "How will I know it's time?" I told her she would know...her body would just start to push.
Eventually, her husband sat with us in the bathroom. He rubbed her shoulders and poured water on her belly. He seemed to be adjusting to the fact that E's behavior was very normal (I had reassured him several times). He was doing a great job being supportive. At one point she asked if it was too late to get IV pain medicine. I checked her and told her she was 8cms and yes it was too late. She accepted that without any problem.
I encouraged her to change her position in the tub. She moved to her side but after one contraction on her side, she said "The baby is coming! I need to push". We assisted her to the bed. I encouraged her to get in whatever postion she wanted. I re-checked her and she was completely dilated. I told her she could have this baby whenever she was ready.
I had 'warned' her about the ring of fire previously but she was still caught off guard by it I think. She held back a little but then just gathered her strength and pushed her baby right out. We had a bit of a mild shoulder getting stuck, but was quickly relieved and both mom and baby were doing wonderfully.
Thursday, December 10, 2009
T's Birth
I had been seeing T all throughout this pregnancy as well as her first pregnancy. A student midwife and I had caught the baby last time. I was looking forward to catching this baby myself! T was kind enough to go into labor during my weekend on call :)
T is an herbalist and does not believe in taking any man-made medicines with the exception of life-saving. Her first labor and birth was done naturally and this one would be the same.
I had just left the hospital to go meet my mother to try and do some christmas shopping when T called me. She told me she had been contracting through the night and the contractions were pretty intense. They were also about every 6 minutes apart now. Her water had broke earlier that morning. I told her it sounded like she needed to come on in.
When she arrived, I was a little nervous because she looked very comfortable, even when having a contraction. She would breathe through the contraction but there were no other signs that she was having one....meaning her body and face were very relaxed. I was thinking that she might be very early in the labor. But I also know that everyone handles pain differently.
We got her settled in her room, got a quick strip of the baby, who looked great. Then we got her in the tub. Her cervix was dilated 5cms at this point! Woohoo! T and I sat in the bathroom for the remainder of her labor. Well, she was in the tub while I sat on a stool beside the tub :) T was amazingly relaxed and seemed to enjoy the tub. We talked about all kinds of things....from family to spirituality! I was worried that I was distracting her from her labor but she assured me that everything was fine. Her contractions eventually began to move closer together, until they were about 2-3 minutes apart. I was really enjoying watching her labor. I was able to tell when she moved into transition...not because she made more noise or anything, just because she stopped talking but still maintained a very relaxed appearance. I could tell that she was becoming more focused and drawing inward. She looked beautiful!
Eventually she told me that she could feel the baby moving down. I rechecked her while she was in the tub...she was 8-9cms now. However, I had a feeling that would be changing quickly. We waited a few more contractions until she felt like she needed to push. I rechecked her to find the baby at +2 station (+3 is crowning) and told her she was definitely ready! We moved her to the bed, where she made herself comfortable. She pushed when she needed to, focusing on her husband, who stood at the bedside. She was absolutely silent. She looked exactly how I would imagine a labor goddess to look :) She pushed with great control for about 6 minutes. She delivered another beautiful baby girl over an intact perineum approximately 2 hours and twenty minutes after arriving!
Congratulations T and I can't wait until the next one!!!!!!!
T is an herbalist and does not believe in taking any man-made medicines with the exception of life-saving. Her first labor and birth was done naturally and this one would be the same.
I had just left the hospital to go meet my mother to try and do some christmas shopping when T called me. She told me she had been contracting through the night and the contractions were pretty intense. They were also about every 6 minutes apart now. Her water had broke earlier that morning. I told her it sounded like she needed to come on in.
When she arrived, I was a little nervous because she looked very comfortable, even when having a contraction. She would breathe through the contraction but there were no other signs that she was having one....meaning her body and face were very relaxed. I was thinking that she might be very early in the labor. But I also know that everyone handles pain differently.
We got her settled in her room, got a quick strip of the baby, who looked great. Then we got her in the tub. Her cervix was dilated 5cms at this point! Woohoo! T and I sat in the bathroom for the remainder of her labor. Well, she was in the tub while I sat on a stool beside the tub :) T was amazingly relaxed and seemed to enjoy the tub. We talked about all kinds of things....from family to spirituality! I was worried that I was distracting her from her labor but she assured me that everything was fine. Her contractions eventually began to move closer together, until they were about 2-3 minutes apart. I was really enjoying watching her labor. I was able to tell when she moved into transition...not because she made more noise or anything, just because she stopped talking but still maintained a very relaxed appearance. I could tell that she was becoming more focused and drawing inward. She looked beautiful!
Eventually she told me that she could feel the baby moving down. I rechecked her while she was in the tub...she was 8-9cms now. However, I had a feeling that would be changing quickly. We waited a few more contractions until she felt like she needed to push. I rechecked her to find the baby at +2 station (+3 is crowning) and told her she was definitely ready! We moved her to the bed, where she made herself comfortable. She pushed when she needed to, focusing on her husband, who stood at the bedside. She was absolutely silent. She looked exactly how I would imagine a labor goddess to look :) She pushed with great control for about 6 minutes. She delivered another beautiful baby girl over an intact perineum approximately 2 hours and twenty minutes after arriving!
Congratulations T and I can't wait until the next one!!!!!!!
Monday, November 9, 2009
Share With Women - Epidurals
SHARE WITH WOMEN - American College of Nurse-Midwives
EPIDURAL ANALGESIA
There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This handout discusses epidural analgesia.
What is Epidural Analgesia?
Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.
How Does an Epidural Work?
All of the nerves of the body send their messages to the brain through the spine. Anesthetics are
medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.
How is an Epidural Done?
There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.
How Well Does an Epidural Work?
For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.
Are There Risks Associated With Having an Epidural During Labor?
Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the
position of your baby, and the strength of your contractions. Most of this is out of your control.
Sometimes an epidural can help and sometimes it makes labor longer and more complicated.
Risks of Insertion and Placement of Anesthesia in the Epidural Space
● The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
● The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
● If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the
sensation of your breathing and need help to breathe regularly.
Risks During Labor
● If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
● Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
● Women who have an epidural are more likely to need medication to make contractions stronger.
● Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
● It may be hard to feel your contractions when you need to push. Pushing takes longer.
● Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.
Risks Afterward
● The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
● Your baby may have a harder time getting started breastfeeding.
● Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
● There is a very, very small risk of permanent paralysis—loss of the ability to move your legs.
What Are the Benefits of an Epidural?
● If the epidural works well, you will not feel the intense pain.
● Sometimes—especially with a first baby—early labor may be long. An epidural can give you a
chance to rest so that you can gather your strength for active labor and birth.
● If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
● If you need a cesarean section, your epidural can be used to make you numb for the surgery.
● Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) have problems during labor or birth.
FOR MORE INFORMATION
Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)
EPIDURAL ANALGESIA
There are many options for managing pain during labor. You might decide before you begin labor that you want pain medication, or you may not want any medications. This handout discusses epidural analgesia.
What is Epidural Analgesia?
Epidural analgesia is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. The anesthetic is like the kind you get when you go to the dentist. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection.
How Does an Epidural Work?
All of the nerves of the body send their messages to the brain through the spine. Anesthetics are
medicines that block the messages from traveling up nerves to the brain. When the pain messages are blocked before getting to your brain, you do not “feel” the pain.
How is an Epidural Done?
There is a very small space around the nerves in your spine. This is called the epidural space. A specially trained doctor or nurse places a thin tube, called a catheter, into this space. You will have to sit on the side of the bed or curl up on your side on the bed. The nurse or doctor will give you a shot of Novocain in your back. Then the nurse or doctor will put a long needle through the area that is numbed into the epidural space. When he or she has found the space, the thin tube will be threaded through the needle, and the needle is removed. A pump is then set up to deliver the anesthesia through the tube into the epidural space during your labor. After birth, the tube will be taken out. The numbness will begin to go away. You will be able to move your legs and walk in a few hours.
How Well Does an Epidural Work?
For some women, an epidural works very well. Within 15 to 20 minutes of starting the anesthesia, they lose feeling below the waist. Many women are so comfortable they can talk, watch television, or even sleep. Occasionally, the epidural does not work as well, and you may continue to feel pain or pressure even though your legs are numb. There is no way to guess who will get a “pain free” epidural and who will have an epidural that does not work completely.
Are There Risks Associated With Having an Epidural During Labor?
Your labor progress depends on lots of things: the size of your pelvis, the size of your baby, the
position of your baby, and the strength of your contractions. Most of this is out of your control.
Sometimes an epidural can help and sometimes it makes labor longer and more complicated.
Risks of Insertion and Placement of Anesthesia in the Epidural Space
● The epidural is inserted sterilely, but there is a small chance of infection at the site where the needle is inserted. A serious infection could cause paralysis or, very rarely, death.
● The needle could hit a nerve and cause nerve damage or paralysis. In most people, the spinal cord is above the area where the needle is placed, which is why this problem is rare.
● If the epidural is incorrectly placed too high in your back or into spinal fluid, you may lose the
sensation of your breathing and need help to breathe regularly.
Risks During Labor
● If your bladder is full, you will not be able to feel it, so you will need a catheter to drain the urine.
● Women who have an epidural have a higher chance of getting a fever during labor, and then the baby may need additional blood work and observation to rule out infection.
● Women who have an epidural are more likely to need medication to make contractions stronger.
● Your legs will be numb. If your baby gets stuck in a “crooked” position, you will not be able to move around to “jiggle” the baby into a good position. This may increase your chance of needing a cesarean section.
● It may be hard to feel your contractions when you need to push. Pushing takes longer.
● Women who have an epidural have a higher chance of needing a vacuum or forceps to help give birth.
Risks Afterward
● The most common risk of an epidural after the baby is born is a “spinal headache.” This only happens one or two times for every 100 epidurals that are used. This is a terrible headache that comes 1 to 2 days after the epidural is removed. If you get a spinal headache, you will need to return to the hospital to have a special procedure called a “blood patch.” The patch usually helps right away.
● Your baby may have a harder time getting started breastfeeding.
● Many women report ongoing back pain after an epidural, but we do not know if this is because of the epidural or because of other things that may have happened during their labor.
● There is a very, very small risk of permanent paralysis—loss of the ability to move your legs.
What Are the Benefits of an Epidural?
● If the epidural works well, you will not feel the intense pain.
● Sometimes—especially with a first baby—early labor may be long. An epidural can give you a
chance to rest so that you can gather your strength for active labor and birth.
● If you are very anxious, an epidural may help you relax. In some women it appears that the epidural may actually make your labor go more quickly.
● If you need a cesarean section, your epidural can be used to make you numb for the surgery.
● Women with twins or babies in a breech position who plan a vaginal birth may use an epidural so they are prepared for a cesarean section if their baby (or babies) have problems during labor or birth.
FOR MORE INFORMATION
Childbirth Connection:
Options: Labor Pain (Epidural and Spinal)
Thursday, October 15, 2009
J's Birth
J was sent over from the office to the hospital for a NST (non-stress test) and to check the fluid around the baby as she was 41.2 weeks pregnant. The plan was for her to come in the next morning to have her water broke as a means of getting labor started. Her cervix was 4cms in the office that day with the baby's head quite low in the pelvis. Diane had called me to let me know she was coming. Diane would be on call the next day.
J had previously had epidurals with her other children. From what she told me, it sounded like she would get to transition then was offered an epidural, where her response was yes. Then she would deliver 30 minutes later. Her previous children were all caught by doctors. She very much wanted to do this natural.
When J arrived and was put on the monitor in triage, I was a little concerned. I didn't like how the baby's heart rate looked so opted to just keep her for the night. Well, I may have jumped the gun because once she came back to L&D, and was on the monitor, the baby looked fantastic. She was also contracting about every five minutes but feeling just a bit crampy with them. I asked her what she wanted to do...stay and break water tonight, stay and do nothing tonight, or go back home. Her and her husband had already made arrangements for their other children (a set of twins and a singleton) and they lived a fair ways away. She decided to stay.
We discussed breaking her water versus not, and she decided to have me check her first. Her husband wasn't there yet but would be in about an hour. She asked if breaking her water would cause her to deliver before he returned. I told "oh no, you won't go that fast!".
Famous last words.
She was 4-5/100/0 when I checked her so she opted to have her membranes ruptured. We even waited until after the nurses' shift change (maybe 20 minutes) before we did it. Once her water was broke, I asked her to walk a bit. She was also looking forward to getting in the tub and trying the birth ball. I went to do some paperwork and saw her walking a bit in the hallway. In hindsight, she looked a bit out of sorts, but at the time I didn't think too much of it.
A few minutes later she went back in the room and the nurse came and asked me if she could have something to eat as she was feeling light-headed. I went in to check on her and she was sitting on the edge of the bed. She told me this was what she didn't like about labor last time either...I suggested some protein as well as carbs. I told her I would be right back to check on her. I went to another patient's room to check in on her. While I was in there the nurse came and stuck her head in the door to tell me that J was asking for an epidural.
I was like "what???" She was doing fine when I had just been in there. So I tell the nurse not to do anything, I'm coming to check on her first. When I get to the room, she's still sitting on the edge of the bed. She tells me I can't do this. Then she grunts and bears down.
I'm thinking "what the heck?" I told J, let me check you before we make any decisions, you haven't tried the tub yet, and it sound slike you are getting close. She was spontaneously bearing down with each contraction. I checked her and she was 9 and a half cms! I said no epidural. She wanted to get in the tub so she squatted in the tub. I sat at her side holding her hand. I started worrying that her husband wasn't going to make it. I don't think she was in the tub more than 10 minutes when she started pushing again. She told me that the baby was coming. I checked and she was certainly correct - she was completely dilated and the baby was at a +2 station. I asked her if she could get out and maybe squat by the bed for delivery (we aren't supposed to do waterbirth although if she hadn't been able to get out, oh well). She was able to move over by a chair in the room. My thought was that she could lean on the chair and I would catch the baby from behind. Not quite how it worked out.
She squatted while I sat on the floor. She had one arm around my shoulders with her other hand on my leg for support. The nurse stood near by, not really sure what to do. She wanted to listen to the baby's heartbeat but I said not to worry about it, we could listen when the baby came out. I could not see what was going on as my head was crushed against J's chest. It was kinda funny :) I kept talking her through her contractions. She would talk completely normally in between contractions, asking what to do. I had one hand at her vagina, where I could feel the head crowning. She slowly and gently pushed the head out. It was such a thrill to not be able to see what I was doing but feel the head being born into my hand. We had a little trouble with the shoulders but nothing that wasn't remedied by me getting both hands involved. She gracefully pushed out the rest of her baby. I brought the baby up to her arms and the nurse threw a blanket over them. The baby was doing absolutely fine as was momma. We helped her move to the bed where she could rest while latching the baby on to the breast. Her husband walked in literally five minutes after the birth.
She pushed out her placenta just as gracefully. She had just a small perineal tear requiring no stitches.
Congrats J on a beautiful birth!
J had previously had epidurals with her other children. From what she told me, it sounded like she would get to transition then was offered an epidural, where her response was yes. Then she would deliver 30 minutes later. Her previous children were all caught by doctors. She very much wanted to do this natural.
When J arrived and was put on the monitor in triage, I was a little concerned. I didn't like how the baby's heart rate looked so opted to just keep her for the night. Well, I may have jumped the gun because once she came back to L&D, and was on the monitor, the baby looked fantastic. She was also contracting about every five minutes but feeling just a bit crampy with them. I asked her what she wanted to do...stay and break water tonight, stay and do nothing tonight, or go back home. Her and her husband had already made arrangements for their other children (a set of twins and a singleton) and they lived a fair ways away. She decided to stay.
We discussed breaking her water versus not, and she decided to have me check her first. Her husband wasn't there yet but would be in about an hour. She asked if breaking her water would cause her to deliver before he returned. I told "oh no, you won't go that fast!".
Famous last words.
She was 4-5/100/0 when I checked her so she opted to have her membranes ruptured. We even waited until after the nurses' shift change (maybe 20 minutes) before we did it. Once her water was broke, I asked her to walk a bit. She was also looking forward to getting in the tub and trying the birth ball. I went to do some paperwork and saw her walking a bit in the hallway. In hindsight, she looked a bit out of sorts, but at the time I didn't think too much of it.
A few minutes later she went back in the room and the nurse came and asked me if she could have something to eat as she was feeling light-headed. I went in to check on her and she was sitting on the edge of the bed. She told me this was what she didn't like about labor last time either...I suggested some protein as well as carbs. I told her I would be right back to check on her. I went to another patient's room to check in on her. While I was in there the nurse came and stuck her head in the door to tell me that J was asking for an epidural.
I was like "what???" She was doing fine when I had just been in there. So I tell the nurse not to do anything, I'm coming to check on her first. When I get to the room, she's still sitting on the edge of the bed. She tells me I can't do this. Then she grunts and bears down.
I'm thinking "what the heck?" I told J, let me check you before we make any decisions, you haven't tried the tub yet, and it sound slike you are getting close. She was spontaneously bearing down with each contraction. I checked her and she was 9 and a half cms! I said no epidural. She wanted to get in the tub so she squatted in the tub. I sat at her side holding her hand. I started worrying that her husband wasn't going to make it. I don't think she was in the tub more than 10 minutes when she started pushing again. She told me that the baby was coming. I checked and she was certainly correct - she was completely dilated and the baby was at a +2 station. I asked her if she could get out and maybe squat by the bed for delivery (we aren't supposed to do waterbirth although if she hadn't been able to get out, oh well). She was able to move over by a chair in the room. My thought was that she could lean on the chair and I would catch the baby from behind. Not quite how it worked out.
She squatted while I sat on the floor. She had one arm around my shoulders with her other hand on my leg for support. The nurse stood near by, not really sure what to do. She wanted to listen to the baby's heartbeat but I said not to worry about it, we could listen when the baby came out. I could not see what was going on as my head was crushed against J's chest. It was kinda funny :) I kept talking her through her contractions. She would talk completely normally in between contractions, asking what to do. I had one hand at her vagina, where I could feel the head crowning. She slowly and gently pushed the head out. It was such a thrill to not be able to see what I was doing but feel the head being born into my hand. We had a little trouble with the shoulders but nothing that wasn't remedied by me getting both hands involved. She gracefully pushed out the rest of her baby. I brought the baby up to her arms and the nurse threw a blanket over them. The baby was doing absolutely fine as was momma. We helped her move to the bed where she could rest while latching the baby on to the breast. Her husband walked in literally five minutes after the birth.
She pushed out her placenta just as gracefully. She had just a small perineal tear requiring no stitches.
Congrats J on a beautiful birth!
Sunday, August 23, 2009
A Day in the Life of a Midwife
Typically we do 24 hours of call at a time or a whole weekend, however there are occasional 12 hour call shifts also. I was on call for 12 hours recently...and it was very busy!
0700 Call starts - I'm in bed.
0745 The first page of the day from Labor & Delivery (L&D). Someone's water has broken - which is ok because she's supposed to be having a baby anyway.
0747 Get up and help the husband get the kids off to school. Avoid the whole raised-by-wolves-look by actually brushing the girls' hair.
0815 Think about getting dressed.
0816 Lay back down.
0820 Get up, get dressed in my fashionable hospital scrubs. Go play on computer (blogs, email, etc).
0840 Page from L&D, patient #1 is ready to deliver
0933 Patient #1 delivers
0950 Start making rounds on the two other laboring patients and charting on everyone
1100 Head to postpartum to see postpartum patients and chart on everyone
1145 Grab some lunch in the doctor's lounge and head over to the office
1200 Pull into parking lot of office when L&D pages, patient #3 that just came in at 8cms and feeling pushy.
1201 Bang head against steering wheel
1202 Head back to hospital with lunch in hand
1215 Arrive at patient #3's room to find her smiling and contracting every 6-7 minutes.
1216 Contemplate stepping outside of room to bang head against the wall but opt not to as I have a headache already
1216 Discuss labor support, etc with patient #3. She doesn't feel like getting out of bed at this point.
1220 Call office and tell them I will try to be there by 2pm
1240 Patient #2 is complete and starting to push, I proceed to spend most of the next hour and a half working with her, while running next door to check on patient #3, who is planning natural childbirth
1300 Call office to tell them I will try to be there by 3pm
1400 Call office to tell them I ain't coming.
1438 Patient #2 delivers.
1500 Patient #3 is hurting and just generally not having a good time. She's still the same exam
1515 I get her in the tub and I sit on the toilet. With a chux over it which turns it into a chair. I realize how bad that sounded.
1530 the tub works its magic.
1545 Patient #3 delivers
Meanwhile patient #4 is gradually getting into labor, which was the goal.
1605 Admit patient #5 for labor
1609 Sit down and try to catch up on charts, without mixing up deliveries and patients
1630 The doc wants to know if I will take over his patient as he is going off call and a doc from another practice will be covering (if the patient is ok with this). The patient (#6) has met me before and is fine with me taking over. She has also been stuck at 8cms.
1635 Bang head against the wall
1636 Utilize the magic peanut with patient #6
1645 Sit and catch up on charts
1700 Re-check patient #4 to determine the next course of action. She's definitely in labor now so onward and forward
1715 Sit down and do nothing for a few minutes.
1745 Re-check patient #6 - complete and ready to go!
1800 Call Lylaine to give report as she comes on call for the weekend
1815 Patient #6 delivers
1840 Check on patient #5, who is doing well and making progress.
1855 Leave the hospital
1900 Off call
Tiffany
0700 Call starts - I'm in bed.
0745 The first page of the day from Labor & Delivery (L&D). Someone's water has broken - which is ok because she's supposed to be having a baby anyway.
0747 Get up and help the husband get the kids off to school. Avoid the whole raised-by-wolves-look by actually brushing the girls' hair.
0815 Think about getting dressed.
0816 Lay back down.
0820 Get up, get dressed in my fashionable hospital scrubs. Go play on computer (blogs, email, etc).
0840 Page from L&D, patient #1 is ready to deliver
0933 Patient #1 delivers
0950 Start making rounds on the two other laboring patients and charting on everyone
1100 Head to postpartum to see postpartum patients and chart on everyone
1145 Grab some lunch in the doctor's lounge and head over to the office
1200 Pull into parking lot of office when L&D pages, patient #3 that just came in at 8cms and feeling pushy.
1201 Bang head against steering wheel
1202 Head back to hospital with lunch in hand
1215 Arrive at patient #3's room to find her smiling and contracting every 6-7 minutes.
1216 Contemplate stepping outside of room to bang head against the wall but opt not to as I have a headache already
1216 Discuss labor support, etc with patient #3. She doesn't feel like getting out of bed at this point.
1220 Call office and tell them I will try to be there by 2pm
1240 Patient #2 is complete and starting to push, I proceed to spend most of the next hour and a half working with her, while running next door to check on patient #3, who is planning natural childbirth
1300 Call office to tell them I will try to be there by 3pm
1400 Call office to tell them I ain't coming.
1438 Patient #2 delivers.
1500 Patient #3 is hurting and just generally not having a good time. She's still the same exam
1515 I get her in the tub and I sit on the toilet. With a chux over it which turns it into a chair. I realize how bad that sounded.
1530 the tub works its magic.
1545 Patient #3 delivers
Meanwhile patient #4 is gradually getting into labor, which was the goal.
1605 Admit patient #5 for labor
1609 Sit down and try to catch up on charts, without mixing up deliveries and patients
1630 The doc wants to know if I will take over his patient as he is going off call and a doc from another practice will be covering (if the patient is ok with this). The patient (#6) has met me before and is fine with me taking over. She has also been stuck at 8cms.
1635 Bang head against the wall
1636 Utilize the magic peanut with patient #6
1645 Sit and catch up on charts
1700 Re-check patient #4 to determine the next course of action. She's definitely in labor now so onward and forward
1715 Sit down and do nothing for a few minutes.
1745 Re-check patient #6 - complete and ready to go!
1800 Call Lylaine to give report as she comes on call for the weekend
1815 Patient #6 delivers
1840 Check on patient #5, who is doing well and making progress.
1855 Leave the hospital
1900 Off call
Tiffany
VBACs Associated with Positive Outcomes
Much controversy surrounds VBAC (vaginal birth after cesarean) today. With an all-time high cesarean section rate of 31.1% nationwide (in 1996, section rates were 14.6%), VBACs are definitely a hot topic. In the 80's and 90's, VBACs occurred at a tremendous rate. Then, true to obstetrical history (where practices are often implemented without adequate research), research was started on this practice. A disturbing trend of complications became apparent, specifically uterine rupture. The VBAC then almost went the way of the albatross, nearly becoming extinct. Doctors and hospitals across the country stopped offering VBACs as an alternative to repeat cesareans due to safety and liability issues.
Uterine rupture is catastrophic if it occurs. It can result in fetal and maternal damage or death. However, the early stages of research included women who had one or more sections, women being induced with prostaglandins (cytotec, cervidil, etc) and/or pitocin. So trully the early research was not an accurate picture of the risk of VBAC. Again, true to obstetrical history, everyone jumped on the bandwagon and stopped offering VBACs.
In the past few years, research has been refined and continues to be improved upon in this area. Now, research tells us that women can safely and effectively VBAC when certain criteria is met. Recently, Obstetrics & Gynecology released a study that yet again found positive outcomes associated with VBACs and negative outcomes associated with elective cesarean. This journal is also known as the 'green journal', and is associated with the American College of Obstetricians and Gynecologists (ACOG).
So research shows us that women having elective repeat cesareans are more likely to have infants with respiratory distress, have less children than women having vaginal deliveries, increased risk of stillbirth, increased risk of placental abnormalities in future pregnancies...not to mention all the risks of having major abdominal surgery (infection, hemorrhage, damage to organs, death). And this is just a brief overview!
For more information regarding cesarean sections and VBACs, check out these links...
Childbirth Connection - Cesarean Sections
Childbirth Connection - VBAC versus Repeat C/S
Navelgazing Midwife
Uterine rupture is catastrophic if it occurs. It can result in fetal and maternal damage or death. However, the early stages of research included women who had one or more sections, women being induced with prostaglandins (cytotec, cervidil, etc) and/or pitocin. So trully the early research was not an accurate picture of the risk of VBAC. Again, true to obstetrical history, everyone jumped on the bandwagon and stopped offering VBACs.
In the past few years, research has been refined and continues to be improved upon in this area. Now, research tells us that women can safely and effectively VBAC when certain criteria is met. Recently, Obstetrics & Gynecology released a study that yet again found positive outcomes associated with VBACs and negative outcomes associated with elective cesarean. This journal is also known as the 'green journal', and is associated with the American College of Obstetricians and Gynecologists (ACOG).
So research shows us that women having elective repeat cesareans are more likely to have infants with respiratory distress, have less children than women having vaginal deliveries, increased risk of stillbirth, increased risk of placental abnormalities in future pregnancies...not to mention all the risks of having major abdominal surgery (infection, hemorrhage, damage to organs, death). And this is just a brief overview!
For more information regarding cesarean sections and VBACs, check out these links...
Childbirth Connection - Cesarean Sections
Childbirth Connection - VBAC versus Repeat C/S
Navelgazing Midwife
Saturday, August 15, 2009
Doula speaks on breastfeeding and labor similiarities, communication
This is a guest post by Katie Dibenedetto, who is a doula I have gotten to work with firsthand. Please enjoy ~ Tiffany
On Tuesday night D called, my new postpartum client. She was worried about her milk supply and is supplementing with formula on the recommendation of the hospital nurses. I sort of gently reminded her that breastfeeding is supply and demand and in order to increase her supply she needs to nurse, nurse, nurse! And also relax! Because so often I see women and they're so tense. They're fretful about the positioning or the baby not latching right away or the baby not nursing for very long and you can see the beads of sweat forming on their brows. But if you can relax and let go and let it flow....you probably will! Same with labor - if you're all tense and tight and holding your breath and clenching....that completely goes against what your body is trying to do - open up.
We talked about how, if she is going to continue supplementing, then for each supplement she needs to pump. Your boobs don't know the baby is getting formula so how will they ever know to make enough milk? I mean obviously I don't want her to be supplementing with formula to begin with - this is another "intervention", "risk", whatever you want to call it of birthing in a hospital with a typical OB and an uneducated nursing staff versus either birthing at home with a midwife or birthing in a hospital or birth center with a supportive team that you love and trust. Hospital staff are all too often completely ignorant about breastfeeding. So they of course encouraged her at the hospital to supplement with formula because she had a 9 pound baby and couldn't possibly make enough milk to satisfy such a big boy's appetite. First of all - way to set a mom up mentally! And second of all - what a great evolutionary design! Let's make women's bodies inadequate so that they don't produce enough milk for their babies. I understand, yes, sometimes there are issues with supply. But in most cases our bodies are perfectly designed to feed our babies a more than satisfactory amount. I just wish people would try more things instead of going straight to formula. But it's just like with birth - I wish people would try more things before going straight to a cesarean. But then you have the ultimate issue - going straight to formula is way easier (for the doctor, nurse, hospital staff, etc. not for the mother obviously) than sitting with a woman for an hour and helping her to relax, reassuring her, helping her find the right position, etc. And going straight to a cesarean is way easier (again for the doctor, hospital, etc.) than having her labor longer and staying with her and helping her walk or change positions or helping her to open up about anything emotionally that she may be holding on to.
Now this is often the hardest part for me about being a doula - to be able to communicate effectively with my moms in a way that is educational and informative, but doesn't make them feel like they have done or are doing anything wrong. And I always try to take an attitude of 'you know, let's acknowledge what we maybe could have done differently and let's deal with any emotions regarding that (I'm not a big fan of denial), but let's move on and focus on what we can do now'. I think this is actually harder for me because I generally just blurt out whatever I am thinking at any given time. Trust me, my husband has spent the better part of our three year marriage trying to teach me "tact". And boy, can I rant and rave with the best of them. It's just another way that being a doula has made me a better person. These communication skills I've learned serve me in all aspects of my life. Anyway, I encouraged D on the phone and she seemed to feel better just talking it out. We set up a time for me to come over the next day."
To be continued...
On Tuesday night D called, my new postpartum client. She was worried about her milk supply and is supplementing with formula on the recommendation of the hospital nurses. I sort of gently reminded her that breastfeeding is supply and demand and in order to increase her supply she needs to nurse, nurse, nurse! And also relax! Because so often I see women and they're so tense. They're fretful about the positioning or the baby not latching right away or the baby not nursing for very long and you can see the beads of sweat forming on their brows. But if you can relax and let go and let it flow....you probably will! Same with labor - if you're all tense and tight and holding your breath and clenching....that completely goes against what your body is trying to do - open up.
We talked about how, if she is going to continue supplementing, then for each supplement she needs to pump. Your boobs don't know the baby is getting formula so how will they ever know to make enough milk? I mean obviously I don't want her to be supplementing with formula to begin with - this is another "intervention", "risk", whatever you want to call it of birthing in a hospital with a typical OB and an uneducated nursing staff versus either birthing at home with a midwife or birthing in a hospital or birth center with a supportive team that you love and trust. Hospital staff are all too often completely ignorant about breastfeeding. So they of course encouraged her at the hospital to supplement with formula because she had a 9 pound baby and couldn't possibly make enough milk to satisfy such a big boy's appetite. First of all - way to set a mom up mentally! And second of all - what a great evolutionary design! Let's make women's bodies inadequate so that they don't produce enough milk for their babies. I understand, yes, sometimes there are issues with supply. But in most cases our bodies are perfectly designed to feed our babies a more than satisfactory amount. I just wish people would try more things instead of going straight to formula. But it's just like with birth - I wish people would try more things before going straight to a cesarean. But then you have the ultimate issue - going straight to formula is way easier (for the doctor, nurse, hospital staff, etc. not for the mother obviously) than sitting with a woman for an hour and helping her to relax, reassuring her, helping her find the right position, etc. And going straight to a cesarean is way easier (again for the doctor, hospital, etc.) than having her labor longer and staying with her and helping her walk or change positions or helping her to open up about anything emotionally that she may be holding on to.
Now this is often the hardest part for me about being a doula - to be able to communicate effectively with my moms in a way that is educational and informative, but doesn't make them feel like they have done or are doing anything wrong. And I always try to take an attitude of 'you know, let's acknowledge what we maybe could have done differently and let's deal with any emotions regarding that (I'm not a big fan of denial), but let's move on and focus on what we can do now'. I think this is actually harder for me because I generally just blurt out whatever I am thinking at any given time. Trust me, my husband has spent the better part of our three year marriage trying to teach me "tact". And boy, can I rant and rave with the best of them. It's just another way that being a doula has made me a better person. These communication skills I've learned serve me in all aspects of my life. Anyway, I encouraged D on the phone and she seemed to feel better just talking it out. We set up a time for me to come over the next day."
To be continued...
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