Teressa's Birth Story

Friday, August 27,th was the day after my due date. I remember it clearly as it was 119 degrees outside, and I was over being pregnant. I decided to swim laps in my pool and walk on the treadmill alternately for over an hour even though I could barely move. I had heard that exercise, pineapple, and lots of walking could bring on contractions, so I did all three. That night, around midnight, I felt my first contractions. I started timing them, and finally decided to go to the hospital around 7am.

I was dilated to 3 cm when they checked me, and I decided to stay. I did a lot of walking at first, and remember asking the nurse at what rate I could expect to progress. She said approximately 1cm an hour, so I remember playing mind games with how well I was doing, and stated at 12 noon I wanted to be checked, expecting to be at least 6-7 cm and almost done. Well....I was at 4 cm at noon, and while the pain was bad- it was somewhat manageable in the tub. I had back labor, so the contractions were painful, but they were far enough apart that I could handle it.
The pain in my back began to worsen around 1pm, and I tried several positions with a ball and in the tub to try to get the baby to turn. I decided the tub was the most comfortable, so I went back there to wait. Shortly after I got in the tub, my midwife had to leave to deliver another baby. It did not seem like I was progressing, so I thought this would be more than fine. By the time the nurse came in to check the baby’s heartbeat the next time, I was yelling in pain and was thankful to throw up to get a break from the pain. My contractions started happening one on top of another, and I felt like I could barely catch my breath. I literally fell out of the tub with each contraction while the nurse was asking me to “rate my pain from 1-10”. I made her leave, and during one horrible one yelled, “I need an epidural now!” to my poor mother sitting outside the bathroom. She ran to get the nurse I had just told to leave, who needed me to get back to the bed to check me first.

It took me about ten minutes to get back to the bed because the contractions literally made me fall over. The nurse thought I was exaggerating my pain I am sure, and thought I was just being dramatic. We got back to the bed, and I was at 6cm, and my water had popped sometime while I had been in the tub yelling. My midwife was still delivering another baby, so she gave the ok for an epidural. I was so frustrated with myself that I had not “stuck it out” with natural childbirth, but I felt like I was passing out and I couldn’t think of an alternative. I remember looking at the clock, which read 3:40pm. I was convinced the clock had stopped for several hours and that it could not possibly still be the same day. The epidural involved getting an IV in and some fluid that the nurse promised would only take ten min. She could not get the IV needle in my arm for about ten minutes, because my contractions were constant. By the time the fluid started entering, I was begging her to make it go faster, and a minute later I was overcome with the urge to push.

The nurse looked at me, somewhat shocked, as it had only been 30 minutes since I was at 6cm, and said she should probably check me. I was at 10cm and could not stop pushing. She ran and got my midwife, who ran in as I was already pushing regularly. This part I don’t really remember at all, but it was not painful. I was on a mission, and it felt like my body took over as if it knew exactly what to do. I was told I pushed for less than 15 minutes, and I kept thinking I had to wait, because my daughter’s father was not there yet.

Amaya Grace was born at 4:08 pm and weighed 9lbs 2 oz and she was 21 inches long. They put her right on my chest, and I will never forget how she squeezed my finger and turned and looked right at me with huge, beautiful eyes. She had a full head of hair, and was absolutely the most perfect miracle I could imagine. It was almost shock I felt that the whole time I had been waddling around in pain, and wishing away my third trimester, I had the most amazing little girl inside me.
Her dad made it about ten minutes later, and was able to cut her umbilical cord. I sat for a long time with her on my chest, not wanting the moment to be over. I felt a great sense of pride in the fact I had made it, although unintentionally for a portion of the time, through natural childbirth, and I was overcome with love for Amaya, as if she had always belonged in my arms, lying on my chest. She is truly an angel sent by God.

Doula Services During Midwife Retreat

It's that time of the year again! It's the time when we five midwives go on a retreat to evaluate our services, assess goal attainment as well as forming new ones. It also gives us the opportunity to strengthen our bonds with each other. Unfortunately, it does leave a short period of time when none of the midwives will be available for call. The dates/times this year are from Thursday, September 23rd at 7pm until Monday, September 27th at 2pm. Dr Rau, a female physician who shares call rotation with our doctors, has graciously agreed to cover the midwives during the weekend from 5pm on Friday until 7am Monday morning. Our own doctors will be available during the remainder of the time.

However, I do have some good news...

Taylor Kalander, a local doula, has also graciously agreed to offer her services for free to those midwifery patients who desire them. She will be available from Friday, September 24th at 6pm until Monday, the 27th at 2pm. Here's a little more info about Taylor...

I am a trained birth doula and postpartum doula working on the last portion of my certifications through Doulas of North America International (DONA). I have experience with multiples, preemies and special needs infants through my work as a nanny. I am a native Southern Californian, but have enjoyed living in Arizona for the last ten years. I am so glad to be working with the clients of Bethany Women's Healthcare and look forward to being a part of your special day!



The nursing staff at Phoenix Baptist Hospital Labor & Delivery have the contact infor for Taylor. If you arrive in labor during those times she is available, simply ask the nurse to contact her! Taylor can also be found on Facebook, Twitter (babylovedoula), and her website will be available soon.



Feel free to contact us with any questions you may have!

S's Birth Story - Graphic pictures

I spent a good bit of time getting to know S and her husband during her pregnancy. I was thrilled when she went into labor while I was on call! The following is her pictorial birth story with some light commentary from me. I thought it was awesome that S's friend and family members were very interested in capturing every aspect of her experience so I asked permission to post, what turned out to be some wonderful photos. GRAPHIC PICTURES ahead!!!!!




The happy (or not-so-happy) couple arrived earlier for a labor check. After walking for a bit and being re-evaluated, it was decided that she should go home. If I remember correctly, she was a couple centimeters dilated at this point.

Once S returned, she got serious about laboring :) She was further dilated, admitted for labor, and tossed in the jacuzzi tub to labor further. She had great support from her husband, mother, and best friend. Her dad was also readily available with any assistance needed.

Fresh out of the tub...

Showing dad some different massage techniques....not the most flattering shot of me :P

Working hard! At this point she was around 8cms but the labor was starting to slow down, leaving her stuck at 8 for a while. S was becoming exhausted after hours and hours of labor. At this point we did have some discussion about pain management options.

S getting some rest once the epidural was in place.

Me and S's husband waiting for a baby to present herself.

Providing perineal support as S pushes the head out.

I assist the new daddy as he catches the baby. You can see the cord :) My finger is not in the baby's eye, just the angle :p

Good sized kid for a first baby. Momma did wonderful, pushing for maybe 45minutes.

A natural....

Cara's Birth Story

Ok, I finally have the opportunity to reflect on my birth experience long enough to share my story with you…

My energy was completely drained for a quick minute here but I have replenished my energy and am ready to take on the world with my new son, Angel Jackson (A.K.A. AJ)

From the moment that I met with my fabulous midwife, Tiffany Jackson, I insisted on going through the birth process with no drugs and doing everything as natural as possible. Tiffany reassured me this was totally possible and reasonable. As I began to share with people my “birth plan” of no drugs, people would laugh at me and tell me I was crazy! Or they would look at me like I grew five heads. I shared these comments with Tiffany and again she reassured me my birth plan was totally possible. I put my faith in Tiffany’s words. So here is how my birth plan played out…

On June 7th, I kissed my husband good-bye and off to work he went. I am a teacher therefore I am blessed to be home from the end of May until August. During the time off, I began to tackle things that I had been putting aside. On the 7th, I got a burst of energy and decided I was going to DEEP clean the house (little did I know that this is called the nesting phase…). I began by bleaching and scrubbing everything I could and ended with carpet cleaning the entire house. My husband had asked me weeks ago to make cheese enchiladas for him as he loves them. I had gone grocery shopping picked up everything to make the enchiladas along with some other goodies. My plan was to take a shower, nap and then make the enchiladas for dinner. I carried out my plan, showered, napped and began to make the enchiladas at about 5:30 p.m. Just as I finished rolling the last enchilada, I felt a trickle of water, as though I had waited too long to get to the bathroom and pee’d on myself. I put the enchiladas in the oven, set the timer and off to the bathroom to handle business. Little did I know this was the start of my water breaking. I sat on the toilet and I pee’d forever, which wasn’t pee as I later found out, this was my water breaking. I called Tiffany and she advised me that it sounds like our son was going to make his arrival earlier than the planned due date of June 24th and to head to Phoenix Baptist Hospital to be checked out.

I waited for my husband to get home and about 6:30 p.m. we headed to the hospital. The contractions were about 3 minutes apart and I started to reconsider at this point my initial birth plan of no drugs. As I sat on the towel in my husband’s car my water continued to flow…..We arrived at the hospital and I instructed my husband to park the car in the parking lot and I could walk to the hospital, all the while reconsidering my no drug plan. I walked into the hospital to be greeted with a wheel chair and a labor and delivery nurse who took me to the labor and delivery floor. I was assigned to an amazing labor and delivery nurse, Stephanie. In the meantime I waited for Tiffany to arrive at the hospital and all the while still reconsidering my idea of no drugs during labor and delivery. Stephanie checked me and I was 5 ½ centimeters at 7’ish. Stephanie put me in the Jacuzzi and what a world of difference this made. I was back to my original mindset of I want to bring my son into this world as natural as possible with no drugs. Tiffany arrived, offering encouragement, compassion, comfort and guidance on how to work through the contractions and the feelings I was experiencing. My husband was my best friend by my side. I couldn’t have asked for a better team to welcome my son into this world!

Tiffany checked me about 9’ish and I was 9 ½ centimeters. With the help of my husband and Tiffany, they removed me from the Jacuzzi and I went to the bed to begin pushing. Stephanie was fabulous with the “Tug of War” pulling and pushing process. This helped me channel my strength into pushing. As I entered the “Ring of Fire” stage of delivery, I “begged” for relief from the pressure that I was feeling in the anal and vagina area. Tiffany, Stephanie and my husband encouraged me to keep going with no drugs as they could see the head. At 10:13pm, AJ was welcomed into this world with my husband, Tiffany and Stephanie by our sides. There was immediate feeling of relief felt both physically and emotionally. Although AJ was born early by 2 weeks, he was healthy and perfect size at 7lbs, 4 oz, 18.5 inches long. Angel Jackson is a blessing to our family and lives.

To all of you that are expecting your child and considering going through with a birth plan of no drugs, have faith in yourselves and your bodies; your body was made to do this. I was told this during a birthing class and didn’t believe it until I actually went through with it. Now, looking back, I wouldn’t change a single thing.

Mother of Many

My daughters stood and watched this with me, throughly absorbed. Thanks to Jill and crew at Unnesecearean where I found this.

A's VBAC story

I had been having surges for the past week off and on. By Saturday night I had called my doula to let her know that we were getting close. On Sunday, I had bloody show so I was wearing a cloth pad and we went to trader joes and while there I felt my legs sorta wet and so we headed home. I definitely had lost some fluid.

I called my doula and so Sunday night she slept the night since I was having contractions every 7 or so minutes and was 80 percent. We tried moving my placenta since it was a bit anterior, but it didn't do a lot of help. I wasn't dilating. Monday I did a lot of walking and the contractions were staying at around 6-7 minutes apart. I again called my doula, she came up around midnight or so from another birth. SHe told me she'd have to head to the other for around 6 am. At around 4:30 I was still having contractions and went to the bathroom and I had a very thick discharge and saw some meconium. We decided that I should probably head into the hospital. She had another doula accompany me. This new doula was very awesome! She was very calming and in spite of not knowing her she was super supportive and helpful. At the hospital they checked me and I had a leak in my fluid so they kept me rather than turning me home. I was 100 percent.

I was having surges every 5-6 minutes at this point. With some walking and rest I wasn't progressing. I was around 2.5 cm around 10 am. I was doing some laps and using the birth ball to get through surges. I swear I was the only one walkin, so I had no idea where all the other birthing moms were. Shortly after that the nurse came in and said that I had to stay on the bed now since she had read the policy and VBAC patients had to be under constant monitoring. At this point, I started crying. I asked to see my midwife. While we waited, the new doula let me know that each thing was my choice and with policies there are ways around it. In my mind I kept thinking that there was just no way I could progress from less than 3 cm to 10 without any movement. The midwife came in and let me know what my options were - stay there and listen or request an AMA form (against medical advice) to allow me to walk. Apparently this policy isn't always enforced, and it is up for review in May. Anyway, while waiting and talking (and plenty of tears) my progression definitely changed. I had been having contractions/surges every 5-6 minutes and after the situation, I had barely 2 contractions over a 45 minute period) and definitely affected how I was feeling about the whole situation. After I signed the form I laid in bed for quite a while and did some thinking. I had received some beads from a birth circle meeting and another set from my friends at a blessingway. I asked for those and thought about all the well wishers I had through this birth. I got up and we tried to do some nipple stimulation and a shower to try to get things going, and I just didn't feel it happening so we requested a breast pump, which I also didn't feel helped the contractions get closer. By this time my doula had come back but was exhausted so shortly after she went home. It was around 6 pm and I spoke with the midwife and we decided that we'd try a small amount of pitocin to try to get my body moving again. I knew that once this happened I'd have to stay on my back so we did some walking again. Ravi and I had a few disagreements - I posted via my blackberry that I needed some "eggplant parmesan" (there's a recipe on the web that "guarantees" labor), and Ravi wanted me to remained focused, I was beginning to waver in my belief that I could get through this. I tried some stadol to get some rest because I had been up for basically 3 days and hopefully it would allow me to relax some. While I was able to get some rest, I wasn’t sure if I had progressed. I asked to be checked (we were minimizing this due to the water being broke) and I was at 4.5. My "agreement" to myself was to do the pit if I wasn't at a 5.

We started the pit and the contractions were within 2 minutes of each other within a few hours but I was in horrible pain. They had been slowly upping the pit and I didn’t feel I was able to handle the pain since I had barely any down time between contractions. I had asked that no order be put for an epidural because I wanted to be sure that I spoke with my midwife again before asking for it. The hospital staff had been mostly awesome to this point because I know they wanted to ask me for an epidural for quite a while but in my birth plan I had asked to not be asked. I called for the nurse and let her know that I wanted the pit turned down. This helped the contractions subside but I knew that wasn’t going to get me closer to having the baby! I was without a doula at this point and was confused and definitely losing focus again. I asked for the midwife, and I swore she was just never coming because every contractions felt like an eternity! While waiting for her to come back, I requested the pit be turned off. The nurse basically told me that if I asked for it, she could, but she couldn’t keep changing it. She turned it off, and I let her know I’d like an epidural. She had to call the midwife who was on her way to get the order. I felt so sad and deserted at this point. No doula, midwife was taking forever, I wasn’t progressing!
Finally just as nurse came in and turned off the pit, the midwife came in and we had a short talk and we agreed that the best bet would be to do the epidural. The anesthesiologist came in and explained the procedure to me. I still think it is a bit funny that they didn’t tell me the side effects of this, but I got the whole “fetal death” talk when I asked for intermittent monitoring. Anyway, we started the pit again along with some antibiotics (this may have happened earlier?) since I had been ruptured for a while and was having cervical checks. The epidural didn’t fully take effect but I was able to get a few hours of sleep. I woke and was feeling the contractions and was able to use breathing to hopefully make them more positive. I had feeling on my left side and most of my vaginal area. Around an hour later I was still awakeand felt the rest of my water break. I asked for the nurse and she came and said I was a 9. I never felt so good in my life! I was getting the urge to “bear down” and she said that it wasn’t time yet. I didn’t really stop myself , but she told me it’d be at least 90 minutes before I’d probably be complete. I looked at the clock- it was 6 am and he was almost all the way in position. Shift change was in an hour. Couldn’t help but think of this! Anyway, the new midwife came in around 6:40 and checked me and said I was definitely at a 10 at this point and baby was fully ready! I could feel that she was trying to help me stretch. She had me do a few test pushes so I’d know what to do. I swear I thought I was pooping (earlier on I had called the nurse to change the bed pad because I swore I pooped, apparently I had farted and there was some show). We worked on where I should be pushing and adjusted the bed (I had wanted to birth squatting but only had use of half a leg so without an additional support person this wasn’t possible. I began pushing with the surges and could feel him progressing again and again. At one point he was crowning and she asked me to feel his head and I said I can’t. Apparently both she and Ravi thought that meant I was giving up, but when I showed them, my arm was too short! Anyway, around 7 am, more people began coming in and I kept saying WHO ARE THESE PEOPLE! It definitely was distracting. A midwife from the UK was in to catch the baby, and I was fine with this, the previous midwife had asked if I was okay with this, which I was. We continued pushing and I felt him begin to come through and was getting tired but knew I had more in me. I was being cheered on by the nurse and two midwives and Ravi. Finally at 7:17, less than 30 minutes of pushing, Rohan Jakob entered the world. I am glad the epidural didn’t fully take effect, without it, I’m sure pushing would have been more difficult. I also am thankful for the entire process of getting this baby here. I now have confidence in my body that I didn’t know I had. I had wavered many times but we made it through.

In the end, he was a vbac and I'm so happy that we were home within 12 hours of his birth. He never left our side :) Official stats (after nursing and pooping and all that jazz)
Born 4/28/10 at 7:17 am19.5 inches long7 lbs, 4 oz13.5'' head

Tons of thanks to my friends who’ve helped me get to this point and especially to Sarah for coming to our house before 5 am to pick up Viveka. I’m so thankful that I knew Viveka was in good hands while we were in the hospital!

Herbal Use in Pregnancy Part II

Continuation of herbal remedies (listed by problem)

• Perineal Care - postpartum use, calendula or comfrey - make a tea, strain and add to a sitz bath. Vitamin E oil or calndula, comfrey, pilewort, St John's wort, symphytum, hydrastis, and achillea creams or ointments can be topically applied to the perineum. Make comfrey tea and soak sanitary pads in the teat, then freeze and use on perineum.
• Postpartum Depression - teas of chasteberry, motherwort, nettle, or raspberry leaf. (Encapsulated placenta is supposed to be wonderful in preventing depression - will get an article up at some point about that!)
• Sleep Problems - take a small bed pillow, open one end, add cloves, mint, and rosemary, and sew up open end.
• Sore Nipples - wash the nipples with infusions of marigold or comfrey and expose to the air or sunlight. Ointments from calendula, comfrey, plantain, St. John's wort, or yarrow are particulary effective in healing cracked nipples and relieving pain. Wipe breasts prior to feeding baby.
• Threatened miscarriage - crampbark or black haw bark taken in the form of a cup of the decoction or drops, or a tincture of chasteberry, or raspberry leaf tea
• Varicose veins and hemorrhoids - tea, capsule, or tonic of blessed thistle. Lotions, compresses, or creams made from comfrey, marshmallow, marigold, plantin, yarow, or hawthorn berries. For hemorrhoids, try pilewort cream combined with an equal quantity of comfrey cream or try echinacea an comfrey teas put into a sitz bath, soak 15-30 minutes.
• Water retention - dandelion leaf, corn silk, or both used in tea form.

I can't stress enough that seeing a well trained herbalist is the best option for trying herbal remedies. There is an extensive list of herbs that are to be avoided during pregnancy and childbirth so be sure to check with your provider or a skilled herbalist prior to trying ANY herbal remedy.

There are numerous books and websites on herbal medicine, which can be found doing a search on the internet.

Information on herbs in this post and Part I are from Childbirth Education: Practice, Research, and Theory 2nd Edition by Nichols and Humenick.

Herbal Use During Pregnancy Part I

Many women are interested in a more natural approach to pregnancy, labor, and birth. This can include the use of herbal remedies to treat common problems, enhancing one's health and well being, or a desire to avoid man-made medications if possible. There are many herbs available to women, with many being safe during pregnancy. The following is NOT an all-inclusive guide to herbal use. There are so many out there that enitire books are written about herbs! I will discuss some of the more common herbs used during pregnancy as well as what to avoid. As always, you should discuss herbal use with your provider before using. Speaking with an herbalist is also a great way to get safe advice.



Herbs are made from one or more plants. It's important to remember that just because it's 'natural', doesn't mean it's safe!



The most common methods for preparing herbs are capsules, teas or infusions, tinctures or extracts, and infused oils. The standard measure for tea is 1 ounce of dried herb or 2 ounces of fresh herb with 1 pint of water. Pour the boiling water over the herb, cover, and steep for 15 minutes, strain and drink! For roots, seeds, or the hard, woody parts measure out the same proportion as the infusions, but boil in the water for 20 minutes. Then strain and drink.



Herbal Remedies (listed by problem)

• Cystitis - corn silk thread, horsetail, or marshmallow in tea form


• Engorgement - the leaves of a green or white cabbage leaf as a lining in the bra - change when they are limp, or grate a potato and add it to the cabbage leaf along with a small amount of hot water. Mash together and apply as a paste to the breasts. Only for engorgement as cabbage leaves are commonly used to dry up milk as well.


• Exhaustion in Labor - infusions of fresh ginger root, alone or added to raspberry leaf tea (don't use the ginger if birth is imminent or in the first postpartum hour. Other options include an infusion of rosemary tea, or a tincture of blue cohosh root.


• Headaches - fill a clean white sock with white rice, and add lavendar, rosemary, cloves, or combination thereof. Sew up the open end of sock and warm in the microwave or chill in the freezer. Apply to the forehead (being careful not to burn yourself!).


• Heartburn - Teas of ginger, Iceland moss, lemon balm, chamomile, marshmallow, meadowsweet, peppermint, or spearmint. Alfalfa tablets can also be helpful and are a good source of iron as well.


• High Blood Pressure - hawthorn and cramp bark combined in tea form.


• Insomnia - nervine tea at bedtime.


• Lactation - teas of comfrey, dill, milk thistle, red clover alfalfa, nettles, fenugreek, hops, and vervain. Borage, blessed thistle, and wood betony as teas act as an antidepressant and increase milk supply. fennel seeds sipped in a tea throughout the day, then chewed and swallowed, improve milk flow and are thought to decrease infant colic.


• Mood Changes - herb baths using the flowers of roses, lavendar, borage, daisies, or chamomile. Teas of raspberry leaf alone or in combo with equal amounts of either spearmint or peppermint teas. St John's wort in capsule or tincture form. Teas of vervainherb, lemon balm, lavendar flower, borage flower, lemon verbena leaf. Fish oil or other sources of omega 3's.


• Morning Sickness - anise, black horehound, chamomile, cinnamon bark, cloves, fennel, gentian, ginger root, hops, Iceland moss, lavendar, meadowsweet, red raspberry leaf, rosemary, spearmint or peppermint teas. Chewing or sucking slippery elm tablets or candied ginger. red raspberry capsules or tonic.


• Muscle Aches - fill a clean white tube sock with natural buckwheat; add clove, chamomile, and lavendar herbs. Sew up the sock and warm or chill the sock. Placed on affected area.


• Pain in Labor - motherwort in tincture form (5-10 drops mixed in a small glass of water every hour), scullcap drunk as an infusion or sipped from a glass of water to which had been added one teaspoon of the tincture, or St John's wort in an infusion, or add 23-30 drops to a glass of water. Black cohosh root in tincture form in half-teaspoon doses.Pasque flower in tea, tincture, or capsule. Basil and gotu kola teas and sage compresses.

To be continued...

Hospital Birth

I enjoy the blogoshphere. I spend a good bit of time reading blogs. Some of the blogs take a more scientific approach to their content, while others include personal stories of birth (good and bad). I sometimes find myself becoming frustrated and saddened though when I read about women's personal experiences when having a hospital birth.

I find it difficult to wrap my mind around some of the horrible birth experiences I have 'heard'. I didn't have wonderful birth experiences, but wouldn't describe them as horrible or bad either. But some of the stories I see on various blogs are almost unreal seeming. There are cases where legal entities were involved in the care of a woman's pregnancy, confining her to the hospital by court order and others where a woman had to travel 5-6 hours from home to have a VBAC (when she had one already at the very hospital that denied her!). Other cases are of hospital births where women were left feeling, at a minimum, dissatisfied but in some cases, traumatized.

I worked as a labor and delivery nurse for four years, in a tertiary center. This meant that we handled high-risk and low risk, shipping out only those whose babies would require immediate surgery after birth. I know bad stuff happens in the hospital. It can be factory-like, unpleasant, women made to feel powerless and not in control of bodies. I don't deny these things.

What I worry about is the focus on negativity around the hospital birth experience. Until homebirth and OOH birth centers are financially and geographically available to all low-risk women, hospital birth is it for some women. It's the only viable option for whatever reason. I make decent money and have health insurance. But I couldn't afford to pay for a homebirth out of pocket! So all the bad press surrounding hospital birth might be disheartening for those who are destined for the hospital as their birthing backdrop. You know how it goes - everyone's quick to share a bad story, but not a good story :p

There are hospitals....and Phoenix Baptist Hospital (PBH) can't be the only one. We midwives at Bethany Womens attend births at PBH and have been there for several years now. I have seen beautiful births - more than I can count. It is possible to have a wonderful, satisfying hospital birth. Look back at the archives for this blog and you will find a small portion of those stories. So this is why I get frustrated it can be good....even great, in the hospital. We do it all the time.

We encourage women to be a partner in their care. It's not our goal to be the dictator. Instead we want to establish a relationship with women and their families. This is the very first step in having a wonderful experience in the hospital. We truly care about our patients. We didn't become midwives because we wanted to be pulled away from our families and work long hours. No, it's about being with women, empowering women, changing their lives for the better. The five of us are very passionate about this. We RESPECT women. And at the end of the day, I think that makes a big difference. I will tell women when doing a consult for prenatal care. Find someone you trust....if it isn't us, I don't care.....find someone you trust, it's critical.

I hate to see women feel alienated by the very fact that they had a hospital birth. What happened to midwifery being about supporting women...all women... regardless of where they give birth? Who decied that it would be impossible to have a satisfying, enriching experience in the hospital? That this could only occur in the home environment? I think that time spent arguing which is better - hospital or home - is time wasted. Time needs to be spent improving options, educating women, improving hospital birth. The birth community needs to stick together. If we had nearly the coheisiveness of American Congress of OB/GYN (ACOG), we'd probably be a heckuva lot further along in our struggles for women's birth rights/rites.

This stuff with women being forced to abide by court mandates of hospital confinement, etc is outrageous and a slippery slope indeed. But it can be better.....and I see the proof of that all the time.

YouTube Changing Birth Culture?

This is an interesting blog post by Amy Romano CNM. She discusses how YouTube could be a potential change agent for birth culture. Cool! A use for technology that is positive and helpful :)

I'll admit....in my desire to share what normal birth looks like, I have 'made' my daughters watch several YouTube birth videos. My 6-year-old, Liberty, finds them absolutely fascinating. She begs to come to work with me and see someone have a baby. I told her maybe someday. My 9-year-old, Daja, is not so interested. But she's also very much a tomboy and shies away from 'female things'. She has been to work with me and watched a birth. She did ok but I don't think she found it as awesome as I always do! She was a little green when the placenta came out. I had hoped to let her touch it (with gloves on, of course) but ended up sending her out of the room. :)

Midwife-led versus other models of care for childbearing women

Midwife-led versus other models of care for childbearing women
Hatem M, Sandall J, Devane D, Soltani H, Gates S
Cochrane.org

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. All models of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.

The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks' gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.

The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

Birth Physiology by Michel Odent

One of our favorite birth advocates, Michel Odent, has some wonderful wisdom and knowledge to share...Read on!

Lylaine

BIRTH PHYSIOLOGY:
AN OVERVIEW

by Michel Odent

What are the basic needs of human mammals when they are giving birth? In spite of thousands of years of cultural interferences, it is possible today to rediscover such needs with the help of a small number of physiological concepts (Odent 2001).

BASIC MAMMALIAN NEEDS

Our current understanding of birth physiology is based on the adrenaline–oxytocin antagonism: when mammals release adrenaline they cannot release oxytocin. We use the word ‘adrenaline’ as a simplified way to refer to the ‘fight and flight system’. Such an antagonism has been understood for a long time and evaluated in relation to myometrial response (Zuspan 1962) and milk ejection response (Whittlestone 1954). The first data have been confirmed by clinical studies among humans (Lederman 1978). Today oxytocin is often presented as ‘the mirror image of adrenaline’. (Uvnas-Moberg 2003).

It is well known that mammals (including humans) release adrenaline in situations such as being scared, feeling observed, or being cold. We can therefore draw the preliminary conclusion that in order to give birth a woman needs to feel secure, without feeling observed, in a warm enough place.

Although the adrenaline-oxytocin antagonism is theoretically established, it is not well-digested knowledge. It disagrees with deep-rooted beliefs. It is still commonplace, in natural childbirth circles, to include recommendations based on the simplistic idea that walking and using the force of gravity will make labour easier. Finding these recommendations strange is not new. As early as 1833, William DeWees wrote that ‘the preposterous custom of obliging her (the labouring woman) to walk the floor with a view to increase the pains when tardy should be preremptorily forbidden’. Today scientific evidence tends to support De Wees’ point of view. Since the prerequisite for labour to establish itself properly is a low level of adrenaline, it is a good sign when a labouring woman does not feel the need to stand up and walk. During the first stage of an easy and fast birth, women are often passive, for example on all fours or lying down. To suggest any sort of muscular activity at that phase can be counter-productive, even cruel.

This belief that a woman in labour should walk can still influence medical circles as well. This is how we can explain the popularity of the term ‘walking epidural’ and also the publication of randomised controlled trials to evaluate the effect of walking on labour and delivery. Of course none of the studies could demonstrate any effect. It is significant that, in the most authoritative of these studies, 22% of the women who were assigned to walking stayed in bed.(Bloom 1998)
In natural childbirth circles, labouring women are also often compared with athletes who are advised to consume large amount of carbohydrates before starting extreme physical exertion, such as running a marathon. Authors of articles about nutrition during labour have suggested that we should learn from sports medicine. Many birth attendants are influenced by these comparisons and encourage women to eat food such as pasta at the onset of labour, and to drink something sweet when labour is established: ‘You need energy!’.

These ideas about nutrition are also in contradiction with our current understanding of the adrenaline-oxytocin antagonism. A low level of adrenaline and good progress in the first stage imply that the striated muscles are at rest. When a birth is as physiological as possible, the labouring woman has a tendency to be immobile during the first stage. When all the skeletal muscles are at rest, such as when the mother is lying on her side or is on all-fours, energy expended is insignificant, and the need for carbohydrates is minimal, insofar as glucose is the favourite fuel of skeletal muscles. The energy expenditure of the uterine muscle is insignificant. Smooth muscles are between 20 and 400 times more energy efficient than skeletal muscles. Furthermore they can easily use fatty acids (rather than glucose) as fuel. In practice there is no risk of fuel shortage for the smooth muscles. The observations by Paterson and colleagues are highly significant. They found that ketone levels were higher in women who had been starved for twelve hours before an elective caesarean under general anaesthesia than they were for women who had been in labour. This confirms that labouring women spend less energy than those who are only waiting for an operation without being in labour.

Comparing labouring women to marathon runners is misleading and potentially dangerous. The side effects of sugar during labour are well documented. There is evidence that when the mother has been given an infusion containing glucose, the risk of lactic acidosis in the fetus is increased and the intensity of jaundice in the neonate is greater (Kenepp et al 1982)..

These theoretical considerations are supported by what we can learn from observation. Mammals in general do not eat during the process of parturition. For several decades, either in a hospital or at home, I have learned from thousands of women who were neither encouraged nor discouraged to eat and drink in labour. Although there are always exceptions, it is possible to summarize several simple observations. The first point is that labour rarely starts when a pregnant woman is hungry. This makes sense since hunger tends to increase the level of catecholamines. Second, when labour is really well established, women do not feel the need to eat.

OVERCOMING THE SPECIFICALLY HUMAN HANDICAP

A specifically human handicap during the process of parturition is the huge development of the neocortex in our species. During the birth process (or during any sort of sexual experience) most inhibitions are related to neocortical activity. In general rational control of the procreative drives is a byproduct of human brain evolution.

The evolutionary process found a way of overcoming this vulnerability. Neocortical activity simply becomes reduced during the birth process. This had not been understood by the Pavlovian physiologists whose theories are, directly or indirectly, at the root of most current schools of ‘natural childbirth’. It is, on the other hand, easily interpreted by those who have the experience of undisturbed, unmanaged and “uncoached” births. When a woman is giving birth easily, without any interference, there is a time when she seems to cut herself off from our world. She becomes indifferent to what is happening around her. She tends to forget her plans and received ideas. She behaves in a way that would be considered unacceptable in the daily life of a civilized woman. When, for example, she dares to scream, or to swear, or to be impolite, it means that there is reduction in neocortical control. She can find herself in the most bizarre, unexpected, and often primitive, quadrupedal and typically mammalian postures. She seems to be “on another planet”. This reduction of neocortical activity is an essential aspect of birth physiology among humans. It implies that labouring women need to be protected against any sort of neocortical stimulation. We must remember the main stimulants of the human neocortex are, if we are to avoid such stimulations.

Language is a specifically human stimulant of the neocortex. When we communicate with language we process what we perceive with our neocortex. This implies, for example, that if there is a birth attendant, one of her main qualities is her capacity to keep a low profile and to remain silent, to avoid in particular asking precise questions. It will probably take a long time for people to realize that a birth attendant must remain as silent as possible. It is difficult to get rid of the after-effects of the Pavlovian theories. Velvovski and other Pavlovian theoreticians had understood the neocortical origins of inhibitions during human parturition. However, probably because they were not practitioners directly involved in childbirth, they ignored the reduction of neocortical control as an essential aspect of birth physiology in our species. They assumed that the practical objective should be to ‘recondition’ women in order to eliminate the inhibitions and to make childbirth painless. From their point of view labour pain is a conditioned reflex, and therefore cultural. Such theories lead to the concept of ‘verbal analgesia’. After visiting the Pavlovian theoreticians in Russia in 1951, Lamaze introduced their concepts in Western countries. This is how the birth attendants started to overuse language and became invasive guides, helpers and even ‘coaches’.

Light is another well-known stimulant of the human neocortex. Electroencephalographers know that the trace exploring neocortical activity is influenced by visual stimulation. We usually close the curtains and switch off the lights when we want to reduce the activity of our intellect in order to go to sleep. This implies that, from a physiological perspective, a dim light should in general facilitate the birth process. These are important considerations in the age of electricity, when we have the power to switch on a bright light simply by pressing a button. It is noticeable that as soon as a labouring woman is on ‘another planet’ she is spontaneously driven towards postures that tend to protect her against all sorts of visual stimulations. For example she may be on all fours, as if praying. Apart from reducing the back pain, this common posture (with many asymmetrical variants) has several positive effects, such as eliminating the main reason for fetal distress (no compression of the vena cava), influencing the process of rotation, and therefore minimizing the mechanical difficulties that characterize human parturition.

Feeling observed is a situation associated with neocortical stimulation. When we feel observed, we tend in return to observe ourselves and to correct our attitude. This is another way to interpret the importance of privacy (i.e. not to feel observed) as a basic need during labour. Understanding the need for privacy makes us anticipate, for example, that there is a difference between a midwife staying in front of a labouring woman and watching her, and another one sitting in a corner. It might also make us anticipate that devices that are perceived by the labouring woman as observing tools (such as a camera or an electronic fetal monitor) should be introduced with extreme caution in a birthing place. The surprise produced by the results of randomized controlled trials comparing the effects on statistics of electronic fetal monitoring versus intermittent auscultation is a symptom of a lack of understanding of birth physiology. It might have been anticipated that the only fact that a labouring woman knows that her body functions are continuously monitored tends to stimulate her neocortex. Stimulating the neocortex risks making the labour longer, more difficult, and therefore more dangerous so that more babies must be rescued via the abdominal route. Photos in books for the general public and videos shown in conferences constitute proof that the need for privacy is not understood by the natural childbirth movements: it is commonplace to see a woman in labour surrounded by several people watching her.

The perception of danger is another possible stimulant of the neocortex. Since in situations of danger it is an advantage to be alert and attentive, neocortical activity is an appropriate response. Analyzing such a situation is another way to consider the need to feel secure as basic during human parturition.

Understanding the solution the evolutionary process found in order to overcome the specifically human handicap in parturition appears today to be a necessary step towards rediscovering the basic needs of labouring women.

BASIC NEEDS DURING THE THIRD STAGE OF LABOUR

Provided there have been no major deviations from the physiological reference during the previous phases of labour, mother and baby share similar basic needs during the third stage. From a physiological perspective there is a key event between the birth of the baby and the delivery of the placenta. It is the high peak of oxytocin that human mothers have the capacity to release immediately after the birth, which is arguably the highest level of oxytocin a woman can reach during her whole life. (Nissen 1995) This peak of oxytocin is vital, since it is necessary for a safe and bloodless delivery of the placenta, and since oxytocin is the main component of the 'cocktail of love hormones' that is supposed to be released in the perinatal period.

Whatever the circumstances, a release of oxytocin is highly influenced by the environment. We must therefore look at the factors that can have a positive or negative effect at the beginning of the mother-newborn interaction. By mixing theoretical considerations and clinical observations we can identify two main groups of factors. At this phase of labour, the vulnerability of mothers to an inappropriate ambient temperature is well known. This is why shivering (a sign of adrenaline release) is a frequent physiological response to an insufficiently high room temperature. In fact, just after the birth of the baby, mothers never complain because the place is too hot, while nonverbally they often indicate that it is not warm enough. The concept of adrenaline-oxytocin antagonism, alongside clinical observation, must bring us to the conclusion that, as soon as the baby is born, the thermo-regulation of the mother must be at rest. In other words, maintaining an appropriate ambient temperature should be the first preoccupation.An undisturbed interaction between mother and newborn is another factor facilitating oxytocin release. During the third stage of labour an appropriate maternal hormonal balance is more easily obtained if, in an atmosphere of privacy, the mother can feel the skin-to-skin contact, can try to establish eye-to-eye contact, and can smell the odour of her baby…without any distractions. Eliminating any distractions is difficult: as soon as a baby is born, there is always an irrational need for activity around; there is always somebody who wants to do something or to say something. This need for activity has been ritualized in many societies. It is impossible to offer an exhaustive catalogue of all the possible ways to interfere with the mother-newborn intimacy. Let us imagine, for example, that a mother is still in such a state of consciousness that she has forgotten the rest of the world while discovering her baby; suddenly somebody appears with two clamps and a pair of scissors in order to cut the cord. This distraction is a dangerous interference with the physiological processes.

At the very time when we are starting to understand the importance of the third stage for the ‘development of the capacity to love’, we have to realize that this particular phase of labour has been dramatically disturbed by all cultural milieus via a great diversity of beliefs and rituals. Furthermore we have to realize that, in the age of the safe caesarean, this phase of labour can be purely and simply eliminated for the first time in the history of mankind.

References

**Bloom SL, McIntire DD et al (1998) Lack of effect of walking on labor and delivery. N Engl J Med; 339: 76-9
**Kenepp NB, Shelley WC et al (1982) Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section. Lancet ii:1150-52
**Lederman RP, Lederman E, Work B, McCann DS (1978) The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol 132(5):495-500
**Nissen E, Lilja G, Widstrom AM, Uvnas-Moberg K (1995) Elevation of oxytocin levels early post partum in women. Acta Obstet Gynecol Scand 74:530-3
**Odent M (2001) New reasons and new ways to study birth physiology. International Journal of Gynecology and Obstetrics 75:S39-S45
**Uvnas Moberg K (2003) The oxytocin factor. Da Capo Press. Cambridge MA

**Wittlestone WG (1954) The effect of adrenaline on the ejection response of the sow. J Endocrin 10:167-172
**Zuspan FP, Cibils LA. Pose SV(1962) Myometrial and cardiovascular responses to alterations in plasma epinephrine and norepinephrine. Am J Obstet Gynecol 84(7):841-851

Delayed Cord Clamping

A common request on birth plans, delayed cord clamping does offer benefits for baby.

Immediate cord clamping is part of routine obstetric procedure in the US. This is part of active management of the third stage (third stage being the time from delivery of the baby to the delivery of the placenta), which is considered optimal for reducing risk of postpartum hemorrhage. The cord is often clamped within 30 seconds of birth. However, there is no practice guideline that indicates when cord clamping should optimally occur. A guideline for what 'delayed' is does not exist either. The various research studies on delayed cord clamping use different time intervals, anywhere from 60 seconds to 3 minutes.

Anywhere from 25% to 60% of the baby's blood volume can be found in the placenta at term. Allowing this blood to return to the baby's circulation after birth can provide the baby with a 30% increase in blood volume and up to a 60% increase in red blood cells. This blood volume increase can contribute as much as 2% of the baby's weight!

The benefits

• Waiting 1-3 minutes in term babies has been shown to result in an increase in Hemoglobin and hematocrit, meaning lower rates of anemia in newborns
• The difference in Hemoglobin and hematocrit continued to be significant at 2 months and 6 months after birth
• Ferritin (iron) stores were significantly higher at 2-3 months of age in infants where delayed cord clamping had occurred
• Delayed cord clamping can increase the rate of hematopoietic stem cells to the newborn, which may play a role in reducing certain blood and immune disorders

The down side

• There is potential for polycythemia (the infant's blood becomes overly thick due to the increase in volume). The studies done on this show mixed results. However, of significance is the finding that no polycythemic infants were symptomatic or required treatment
• Several studies again show mixed results regarding hyperbilirubinemia (elevated bilirubin levels cause jaundice and sometimes require treatment with phototherapy).
• Transient tachypnea (faster than normal respiratory rate in the newborn) may occur as a result of delayed lung fluid absorption casued by an increase in blood volume realted to delayed cord clamping. One study showed that no additional respiratory support was necessary in these infants while another study showed that similar numbers from each group (delayed versus immediate clamping) reuired additional support

FYI

• Immediate cord clamping is not formally a component of active management for prevention of postpartum hemorrhage. Research provides no evidence that this practice increases the risk of hemorrhage
• There is some question of where the newborn should be placed to allow optimal transfusion of placental blood. Not much research has been done on this particular topic.

The midwives of Bethany Womens Healthcare routinely delay cord clamping :)

Eichenbaum-Pikser, G. & Zasloff, J. (2009). Delayed Clamping of the Umbilical Cord: A review with implications for practice. Journal of Midwifery & Women's Health, 54(4), p321.

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...

I Can't Do This - birth story

S was scheduled to come in for an AROM induction (where the membranes are ruptured to hopefully bring on labor) the following day as her cervix was very ready at 4/80/-1. This would be her third baby. She had epidurals with the previous two but was really wanting to have natural childbirth this time.

S came in the day before the induction was scheduled with increasing contractions that felt stronger. Her exam was basically the same so I offered to go ahead and break her water, which she promptly agreed to :) There was clear fluid and the baby was quite the happy camper so I sent S off to walk. I wanted her to wait until the contractions were becoming more uncomfortable before using the jacuzzi tub. She walked for a bit with her boyfriend and I attended to someone else who was also laboring naturally for a bit (it was a busy 6 hours of running back and forth between the two!).

After maybe an hour, S was starting to feel more intense contractions about every 3-4 minutes, so in the tub she went. She stayed in the tub, doing squats or just lying back resting. After some time had gone by, her contractions seemed to be spacing out a bit and less intense, so I suggested walking again. I suspected that the baby may have been OP or 'sunny-side up' due to the back pain she was experiencing and the fact that labor wasn't progressing quite as fast as I thought it would (shows how much we can predict these sorts of things!).

The walking seemed to do the trick, as her labor began to pick back up again. She was also feeling a little pressure so we decided to check her cervix prior to getting her back in the tub. She was 7/90/-1 which was great progress. Things began to really pick up speed at this point. She stayed in the tub for a bit. The night shift nurse came on around this time, and happened to be a very NCB friendly nurse by the name of Kim. Fortunately Kim was able to sit tubside when I would need to leave to check on my other lady. Unfortunately, I would come back to find S getting more agitated and restless. I would then sit with her and she seemed to become a little more at ease. My other lady got an epidural around this time so was able to focus more time on S.

S started to feel more pressure so we got her out of the tub and checked her - she was now 8-9/100/0. But she was definitely hitting that transition phase. She was starting to say 'I can't do this Tiffany' over and over. She was becoming very restless. I got her back in the tub. She was asking for pain medicine but I had told her that it was too late...that she was moving along quickly now....she could do this even if it felt like she couldn't. Maybe fifteen minutes later, she started pushing in the tub. I decided to attempt to check her while in the tub as I didn't want to make her move unless it was time for the birth (unfortunately, we are not doing waterbirths...yet). She was definitely ready - 10/100/+1-2. So she got out of the tub and wanted to sit in the bed to push. She pushed for maybe 10 minutes, the entire time telling me that she couldn't do this :) She pushed out her first daughter with wonderful control over an intact perineum!

The first thing she immediately afterwards?



"I did it!"

Tiffany

ROM+2hrs=birth

I had a woman by the name of E come in for her postpartum visit recently and we were re-visiting her birth story. She graciously has allowed me to share her birth story here!

E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.

I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.

She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.

She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).

I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!

Tiffany