It's amazing to see how much a baby 's head, hand, or even neck can make labor so vastly different, harder, longer, and more difficult. So many times, I have heard of women who have "week" long labors or "all back" labors and midwives who participate in them in their hands-off practice. For a while now, I have been so frustrated with the mentality that long labors are normal and good. Even more so, I have been more frustrated with myself because I agree with labor being natural and not rushing the process, but the long part bothers me.I want to feel that a woman should have all the time she needs to deliver, but in my heart, it doesn't feel right. Let me explain:
Three and a half years ago. Melody and I had a client who took it upon herself to take castor oil without telling us. She told us after the fact when she was having contractions every five minutes. She started the conversation with "I have a story to tell you" and proceeded to tell us how she took castor oil in the afternoon and was having these "cramps" every few minutes. We felt it necessary to go check on her. When we arrived she was six centimeters and her water broke. Oddly enough after her water broke, her contractions spaced out to being irregular. She did this for another 18 more hours. I could not figure out how in eighteen hours, there was no longer progression! 18 hours at 6 centimeters! Some would say, "well, it's her first baby. she will do it." " It's her first baby: first babies take a long time." Melody really didn't want to intervene, but I couldn't take it anymore. Something was not right. But of course, she and I had been wanting to be more "hands-off" in our practice since we came from a more pro-active background and being labeled as such. We wanted to do let the body do it's thing. Finally, Melody checked and this baby was persistently OP (occiput posterior) or face-up. I am sure that I can be ridiculed easily for being a midwife and having such nasty thoughts such as "long labors can't be normal" and maybe even thinking that there's gotta be another way! Well, there is!
Honestly, Melody and I were struggling to agree on this labor...she desiring to let things be and I wanting to help it along and do something. Now I know that there is this thing about hiring a midwife and wanting her to be a guide...and wanting a "hands-off" birth, but you are also hired as a healthcare provider and you stil have a job to do. So rather than COMPLETELY laying off, I believe there are some signposts to intervening. Melody finally got online and discovered Spinning Babies : http://www.spinningbabies.com/ . At the time there was an excercise we found what I now call "The Roll" , where the woman switches positions in labor and in certain time to help baby get back in the correct and perfect position. Imagine that, taking control of the situation to avoid transport for failure to progress or maternal exhaustion. I don't want to sound threatening, but I got very tired very quickly with seeing Mama's labor longer than they had to; so we found another midwife who has a solution! I firmly believe that malpresentation is a big reason that women "fail to progress" and/or have week long prodromal labors and these postional excercises have done wonders!
For example, with our above client: we went to her and said okay time to work and get this baby out...she was very okay with this being ruptured for 18+ hours and having annoying contractions. So we did the "Rebozo", then the suggested roll from Gail Tulley , then Mama stood up and said OOOOOOOWWWWWWW .....90 minutes later, she was holding her son. Yes, being at 6 cms for 18+ hours, she went from 6 to complete and baby out (first time mom) in 90 minutes!! Time and time again, I have used the rebozo and "the roll" and had women either kick into labor and/or progress quickly.
Now, how can you tell what position the baby is in? Well, it's not just by palpation. The baby's back can be on the left and right side and still have the head be posterior or even ascynclitic. But so how can you tell? Well, unfortunately mainly by doing an internal exam. I know that so many women and their midwives don't really believe in it or prefer not to do many if any at all; but I have found that 1-4 minutes of discomfort can save a woman from being transported or even several hours added to her labor. Now,I am not trying to be an interventive midwife, I am trying to be a midwife that feels birth is sacred and beautiful so I will do what it takes from it turning into a traumatizing experience.
Wednesday, August 19, 2009
Friday, August 14, 2009
Pizza Hut + Adjustment = I Didn't Get My Crying Moment!
Date : April 27,2009
I cannot explain the importance of Pizza Hut in my practice. In fact, no one can, but since Melody and I had a homebirth practice in Arkansas, everytime we went to eat at Pizza Hut, we had a great birth that followed. We tried it last December and it worked both times. We went yet again to see if it would work in January and it didn't fail us ....brought forth a fast and beautiful birth!
So after explaining the pizza hut thing to a client of mine who had been 4 cms for about 2.5 weeks, she asked if we could go to Pizza Hut. I said if I was able to soon , we would go!
She was going to come in on her due date for a regular prenatal and her sister was in town. I found an open slot and decided to ask her if she wanted to go to Pizza Hut that day after her appointment. It was perfect: raining + pizzahut +Dr Kristen (our chiro) coming in = BIRTH?
She had her prenatal and was 4cms with her cervix being dilated unevenly leaving me thinking the baby's head was kinked. We did the rebozo and she went ahead and had an adjustment and began to contract somewhat and she could feel a change in baby's position. We checked her cervix and she was 5 cms! She was in shock, and when her sister tried to call her husband, he wouldn't believe her! I had to convince him to go get his stuff and come right away. Meanwhile it was time for lunch and off we went to Pizza Hut!
While at Pizza Hut, My client began to contract but wouldn't believe she was in actual labor...
all I could do was laugh, cause I just knew we were having a baby that night. I told my client that she would be good to get another adjustment and as we left lunch, that's exactly where we were headed to do! THe contractions were coming closer together and more intense. I don't believe her husband could believe she was in labor. Her contractions would not come closer than every 5 minutes and I had asked her how she was coping. All she could say to me was how scared she was of it no being real and the pain intensifying. I immediately got Dr Kristen to do NET to work on her fear and emotional hangups and as soon as that was gone, she went right into active labor. She and her husband finally decided to call in their network of supporters and one by one , they all came in. They began to come in right about 6 o'clock that evening and she was coping beautifully. You couldn't even tell she was in labor! Around 8pm, she went upstairs to escape the crowd and begin to really focus. She was so calm , so quiet. I checked shortly thereafter and she was 8 cms! I was shocked! I gave her choices and knew she wanted to try for a water birth. She wanted to be over and she decided to change clothes to get in the tub. As I began to prepare the tub, I heard her husband yell she's feeling pushy and the SPLAT! Her water broke and went everywhere. The birth team quickly cleaned up and got her into the tub and two pushes later she was holding Baby Alyssa Anne in her arms. You couldn't even hear her push nor see it..it just happened. She looked at her baby and looked up and said "I didn't even get my crying moment!" She couldn't believe she came so fast...oh well, I guess the secret is in the sauce!
I cannot explain the importance of Pizza Hut in my practice. In fact, no one can, but since Melody and I had a homebirth practice in Arkansas, everytime we went to eat at Pizza Hut, we had a great birth that followed. We tried it last December and it worked both times. We went yet again to see if it would work in January and it didn't fail us ....brought forth a fast and beautiful birth!
So after explaining the pizza hut thing to a client of mine who had been 4 cms for about 2.5 weeks, she asked if we could go to Pizza Hut. I said if I was able to soon , we would go!
She was going to come in on her due date for a regular prenatal and her sister was in town. I found an open slot and decided to ask her if she wanted to go to Pizza Hut that day after her appointment. It was perfect: raining + pizzahut +Dr Kristen (our chiro) coming in = BIRTH?
She had her prenatal and was 4cms with her cervix being dilated unevenly leaving me thinking the baby's head was kinked. We did the rebozo and she went ahead and had an adjustment and began to contract somewhat and she could feel a change in baby's position. We checked her cervix and she was 5 cms! She was in shock, and when her sister tried to call her husband, he wouldn't believe her! I had to convince him to go get his stuff and come right away. Meanwhile it was time for lunch and off we went to Pizza Hut!
While at Pizza Hut, My client began to contract but wouldn't believe she was in actual labor...
all I could do was laugh, cause I just knew we were having a baby that night. I told my client that she would be good to get another adjustment and as we left lunch, that's exactly where we were headed to do! THe contractions were coming closer together and more intense. I don't believe her husband could believe she was in labor. Her contractions would not come closer than every 5 minutes and I had asked her how she was coping. All she could say to me was how scared she was of it no being real and the pain intensifying. I immediately got Dr Kristen to do NET to work on her fear and emotional hangups and as soon as that was gone, she went right into active labor. She and her husband finally decided to call in their network of supporters and one by one , they all came in. They began to come in right about 6 o'clock that evening and she was coping beautifully. You couldn't even tell she was in labor! Around 8pm, she went upstairs to escape the crowd and begin to really focus. She was so calm , so quiet. I checked shortly thereafter and she was 8 cms! I was shocked! I gave her choices and knew she wanted to try for a water birth. She wanted to be over and she decided to change clothes to get in the tub. As I began to prepare the tub, I heard her husband yell she's feeling pushy and the SPLAT! Her water broke and went everywhere. The birth team quickly cleaned up and got her into the tub and two pushes later she was holding Baby Alyssa Anne in her arms. You couldn't even hear her push nor see it..it just happened. She looked at her baby and looked up and said "I didn't even get my crying moment!" She couldn't believe she came so fast...oh well, I guess the secret is in the sauce!
Can we say Polyhydramnios???
Okay, so I haven't posted in a while, but life has been so busy! I am really trying to blog more because I just have such great material! I have also been inspired after watching the movie Julie &Julia (a must see). I am going to back track a bit since I have been itching to put these stories down so here I go again...
Date: February 6, 2009
Time: Too Early At 8am!
Now, I am sure that 8am isn't all that early, but after only sleeping 90 minutes, 8am is painful. I had deliverd a baby around 4am that morning to woman who was 39 weeks along as well as her birthday! Let me not forget to mention it was also her sister-in-law's due date. This was baby#9 and she hadn't ever birthed early much less on her birthday! She was concerned upon going into labor because her sister-in-law was also using my services and stirring up as well. She finally decided to call her sister-in-law (Joanne) at 5am to tell her of the birth. *Now two weeks prior, Joanne had pulled an all-nighter false labor run. I had assured her that all was well and baby would come eventually and it's all a part of the job! She had been concerned because she knew this would be her biggest baby yet! Fast forward two weeks and you can imagine her envy of wanting to see her baby NOW! Besides, it was HER due date!* I made sure my client was stable and finally drifted to sleep only to be awakened 90 minutes later which brings us to an early 8am when the phone rang! It was Joanne's husband saying that Joanne had been laboring for a bit and her contractions were 3 minutes apart and intense! I, half aleesp, assured him that all was great and to call me when her contractions pattern out and become intense. Needless to say he hung up confused and later told me that in his mind he was thinking "that's why I am calling you now!" I immediately came to and called him right back saying I was on my way! I waited to alert everybody to come until I had evaluated Joanne to verify she was in labor. As I walked in through the back door, Joanne was in the spa in the box with her eldest child Yolanda pouring water on her back. It was the sweetest thing. I quickly realized her intense contractions and called the students. They, Joanne's sister and mother were on her way. Her mother was coming from her son's house taking care of her daughter-in-law who had delivered with me just a few hours before! As I was preparing my equipment and for staying I notice a small bottle of castor oil on her night stand. I then told her how I just knew she was determined to NOT go another day without holding her baby girl.
Hours went by and after very intense contractions (mostly in her back) and hardly any cervical change at 6cms, they asked me if I would consider breaking her water to help progress. I knew the baby was in a bad position (posterior' face up') and offered to do some positional excercises before rupturing membranes so we had a better chance of locking baby girl in a better position. After those excercies, I thought and agreed to break waters. I know, I know, intervention! But I had much to consider...From what I know , this baby consistenly wanted to stay posterior, and there was Joanne's history...She transferred to the hospital with her eldest which after being posterior for a couple of days, turned and came vaginally and her second was several hours yet. This was Joanne's first with us, but I should have known that baby #3 would follow the same as her siblings births!
Note** We have discovered for ourselves that third babies are the most unpredictale, but for us for this year, that meant most challenging!**
I decided and felt in my gut that we should carry on with breaking her water. I had Melody "pinhole" it since the baby's head was somewhat high to help guide her head down and make sure it was in the right position. As she did this, water GUSHED out. Now, we were expecting more baby less water, but that water kept pouring out and as it did, Melody felt the baby's face! We immediately repositioned Joanne so that we could get baby out of the pelvis and readjusted. And that's exactly what happened! PTL! Baby turned and went head down. Now , Melody said she didn't think the baby was over 8lbs as we had suspected and that she wasn't exactly sure of head position, but we were fine with that as long as it was head presenting and not face! The thing was that her water kept gushing and it seemes as if she had lost over a gallon and it was still flowing! I have never seen so much water. Finally the word polyhydramnios came out of our mouths and we set back and wondered if this was it UNDIAGNOSED.
As Joanne kept laboring, she was feeling more and more pushy. We gave her the go ahead to push minimally with each contraction and as she did, her hubby brought out the laptop to research this polyhydramnios. It wasn't long before he closed it and said, "I don't need to know about that right now." When, Joanne reached 9.5 cms we, she really had the urge to push and did so for almost 45 minutes. I had her stop to rest so that she could renew her energy. After resting for about 20 min, her pushing was involuntary. We set up for delivery and being that she continued pushing for another 45 minutes, I knew this baby was posterior (face up)! She was pushing for a long time for a third timer! As her pushing came to an end, Kayla Rose was born looking up at Daddy! It was a wonderful moment, but an alarming one for me. What happened to our 8lb baby? She was tiny and young looking. She breathed and cried and nursed right away. But the first scary moment occurred shortly after nursing. While Daddy was holding her, Kayla stopped breathing and as we stimulated her cry, she began to spit up what we originally thought was mucus but resembled the colostrum. As she stabilized, we put her in the bath with momma. It was a sweet moment for them, but I wasn't comfortable yet? How was there so much water and so little baby....this must have been polyhydramnios. Melody and I began to research... This baby was tiny and appeared to be a young gestational age. After her bath, I performed her newborn exam and dated her to only be 34 weeks along and her color was looking pretty ashy. How was this possible?? She was born on her due date with sonograms confirming! We were open and honest with all involved when we discoverd that this was more than likely polyhydramnios and that the baby needed to be examined! How did I miss this? I kept thinking to myself. Melody got on the phone with a CNM and I read more. Was this baby SGA(small for gestational age), IUGR(intrauterine growth retardation), or was it Esophageal issues indicative of polyhydramnios? Something wasn't right but I could not put my finger on it. Kayla continued to choke and spit up and as others wanted to chalk it up to transition, I knew something was wrong. Both Melody and myself knew this baby needed to be seen right away and the CNM urged Daddy to take her in. The family did not want to take Kayla anywhere if it was unnecessary, BUT this WAS necessary according to my heart and gut! IT was Friday afternoon at 5pm, no one would be available, We urged them to take Kayla to Cooks Children's Hospital in FW and Daddy made the executive decision to go! I had called the ER to let them know of Kayla's arrival. Being I hadn't slept and the inability for all of us to be in the exam, I opted to go home and sleep before rejoining at the hospital and all agreed we would part for now (6pm).
At 7:30pm, I had called to see if there was any news. I was praying that all would be fine, but my gut told me different. They had said that the ER was waiting for them and rushed them into the exam room. The Dr. felt there wasn't anything to worry about and would do an XRay and test and probably send them home. I hung up humbled and with a heavy heart thinking I made them go for nothing. At 9pm, I received a phone call from Daddy saying that I was right. "How am I right?" I asked. Kayla has esophageal atresia and needs to have surgery right away and on the way up to ICU....NO! I sat there blaming myself wondering what I could have done to prevent this...so far, nothing! I told them I would be at the hospital the next day.
The next morning I received a call from Joanne's mother stating time of surgery and saying that Kayla's rectum was perforated...Great! another thing I missed! She reassured me with the fact that Kayla had gone through 2 Drs that missed the diagnoses. Kayla's surgery that afternoon would fix her esphogus ....poor baby! Her esophagus was not attached to the stomach and had formed a pouch, thus her spitting up since birth! We went to the hospital and I was blessed to have seen Joanne and Kayla just before surgery. That little 5.6 pounder was a fighter but I hated seeing her all tubed up! Joanne was doing so well for just having given birth, I was proud of the way she handled it all...with grace!
After 3 some hours of waiting, Kayla made it through surgery and was on her way for recuperation. She was supposed to be in the hospital for a month and that miracle baby was out in two weeks. I call her a miracle baby because we had heard of other babies born with the same problems who had longer hospital stays and who did not survive. According to the Doctor, there is a small window to perform the surgery and if it's not done then, life would be compromised! Kayla Rose is a happy, beautiful baby who survived and though she still deals with a feeding tube and doctor visits, it does not bring her down, she smiles with grace over her life!
***How did I miss this....Esophageal Atresia can be detected by ultrasound after 28 weeks, Joanne's last sono was at 22 weeks. Joanne's fundal height measured right on and sometimes under her weeks. What I thought I palpated as part of the baby's back was indeed all of it and what I thought was forehead was possibly her whole head! I had also palpated for fluid level wich had minimal thril.
***How was this a God thing: Had I caught this beforehand, we would have had to transfer Joanne out of care. Being in the hospital and having her labor stall with little progression would have caused a nurse to break water without the same caution , hence face presentaion would have occurred and Joanne would have likely had a c-section. With the problems arising, Kayla would have been transferred to Cooks and gone through surgery in one hospital while her mother was recovering at another! In our ignorance, Joanne was able to have her homebirth, spend a precious first few hours with her daughter without being tubed and tied to a NICU bed, and spent every moment with her daughter even just before and after a serious surgery.
Thank you, Lord for ignorance and the grace you showered us in this situation!
Date: February 6, 2009
Time: Too Early At 8am!
Now, I am sure that 8am isn't all that early, but after only sleeping 90 minutes, 8am is painful. I had deliverd a baby around 4am that morning to woman who was 39 weeks along as well as her birthday! Let me not forget to mention it was also her sister-in-law's due date. This was baby#9 and she hadn't ever birthed early much less on her birthday! She was concerned upon going into labor because her sister-in-law was also using my services and stirring up as well. She finally decided to call her sister-in-law (Joanne) at 5am to tell her of the birth. *Now two weeks prior, Joanne had pulled an all-nighter false labor run. I had assured her that all was well and baby would come eventually and it's all a part of the job! She had been concerned because she knew this would be her biggest baby yet! Fast forward two weeks and you can imagine her envy of wanting to see her baby NOW! Besides, it was HER due date!* I made sure my client was stable and finally drifted to sleep only to be awakened 90 minutes later which brings us to an early 8am when the phone rang! It was Joanne's husband saying that Joanne had been laboring for a bit and her contractions were 3 minutes apart and intense! I, half aleesp, assured him that all was great and to call me when her contractions pattern out and become intense. Needless to say he hung up confused and later told me that in his mind he was thinking "that's why I am calling you now!" I immediately came to and called him right back saying I was on my way! I waited to alert everybody to come until I had evaluated Joanne to verify she was in labor. As I walked in through the back door, Joanne was in the spa in the box with her eldest child Yolanda pouring water on her back. It was the sweetest thing. I quickly realized her intense contractions and called the students. They, Joanne's sister and mother were on her way. Her mother was coming from her son's house taking care of her daughter-in-law who had delivered with me just a few hours before! As I was preparing my equipment and for staying I notice a small bottle of castor oil on her night stand. I then told her how I just knew she was determined to NOT go another day without holding her baby girl.
Hours went by and after very intense contractions (mostly in her back) and hardly any cervical change at 6cms, they asked me if I would consider breaking her water to help progress. I knew the baby was in a bad position (posterior' face up') and offered to do some positional excercises before rupturing membranes so we had a better chance of locking baby girl in a better position. After those excercies, I thought and agreed to break waters. I know, I know, intervention! But I had much to consider...From what I know , this baby consistenly wanted to stay posterior, and there was Joanne's history...She transferred to the hospital with her eldest which after being posterior for a couple of days, turned and came vaginally and her second was several hours yet. This was Joanne's first with us, but I should have known that baby #3 would follow the same as her siblings births!
Note** We have discovered for ourselves that third babies are the most unpredictale, but for us for this year, that meant most challenging!**
I decided and felt in my gut that we should carry on with breaking her water. I had Melody "pinhole" it since the baby's head was somewhat high to help guide her head down and make sure it was in the right position. As she did this, water GUSHED out. Now, we were expecting more baby less water, but that water kept pouring out and as it did, Melody felt the baby's face! We immediately repositioned Joanne so that we could get baby out of the pelvis and readjusted. And that's exactly what happened! PTL! Baby turned and went head down. Now , Melody said she didn't think the baby was over 8lbs as we had suspected and that she wasn't exactly sure of head position, but we were fine with that as long as it was head presenting and not face! The thing was that her water kept gushing and it seemes as if she had lost over a gallon and it was still flowing! I have never seen so much water. Finally the word polyhydramnios came out of our mouths and we set back and wondered if this was it UNDIAGNOSED.
As Joanne kept laboring, she was feeling more and more pushy. We gave her the go ahead to push minimally with each contraction and as she did, her hubby brought out the laptop to research this polyhydramnios. It wasn't long before he closed it and said, "I don't need to know about that right now." When, Joanne reached 9.5 cms we, she really had the urge to push and did so for almost 45 minutes. I had her stop to rest so that she could renew her energy. After resting for about 20 min, her pushing was involuntary. We set up for delivery and being that she continued pushing for another 45 minutes, I knew this baby was posterior (face up)! She was pushing for a long time for a third timer! As her pushing came to an end, Kayla Rose was born looking up at Daddy! It was a wonderful moment, but an alarming one for me. What happened to our 8lb baby? She was tiny and young looking. She breathed and cried and nursed right away. But the first scary moment occurred shortly after nursing. While Daddy was holding her, Kayla stopped breathing and as we stimulated her cry, she began to spit up what we originally thought was mucus but resembled the colostrum. As she stabilized, we put her in the bath with momma. It was a sweet moment for them, but I wasn't comfortable yet? How was there so much water and so little baby....this must have been polyhydramnios. Melody and I began to research... This baby was tiny and appeared to be a young gestational age. After her bath, I performed her newborn exam and dated her to only be 34 weeks along and her color was looking pretty ashy. How was this possible?? She was born on her due date with sonograms confirming! We were open and honest with all involved when we discoverd that this was more than likely polyhydramnios and that the baby needed to be examined! How did I miss this? I kept thinking to myself. Melody got on the phone with a CNM and I read more. Was this baby SGA(small for gestational age), IUGR(intrauterine growth retardation), or was it Esophageal issues indicative of polyhydramnios? Something wasn't right but I could not put my finger on it. Kayla continued to choke and spit up and as others wanted to chalk it up to transition, I knew something was wrong. Both Melody and myself knew this baby needed to be seen right away and the CNM urged Daddy to take her in. The family did not want to take Kayla anywhere if it was unnecessary, BUT this WAS necessary according to my heart and gut! IT was Friday afternoon at 5pm, no one would be available, We urged them to take Kayla to Cooks Children's Hospital in FW and Daddy made the executive decision to go! I had called the ER to let them know of Kayla's arrival. Being I hadn't slept and the inability for all of us to be in the exam, I opted to go home and sleep before rejoining at the hospital and all agreed we would part for now (6pm).
At 7:30pm, I had called to see if there was any news. I was praying that all would be fine, but my gut told me different. They had said that the ER was waiting for them and rushed them into the exam room. The Dr. felt there wasn't anything to worry about and would do an XRay and test and probably send them home. I hung up humbled and with a heavy heart thinking I made them go for nothing. At 9pm, I received a phone call from Daddy saying that I was right. "How am I right?" I asked. Kayla has esophageal atresia and needs to have surgery right away and on the way up to ICU....NO! I sat there blaming myself wondering what I could have done to prevent this...so far, nothing! I told them I would be at the hospital the next day.
The next morning I received a call from Joanne's mother stating time of surgery and saying that Kayla's rectum was perforated...Great! another thing I missed! She reassured me with the fact that Kayla had gone through 2 Drs that missed the diagnoses. Kayla's surgery that afternoon would fix her esphogus ....poor baby! Her esophagus was not attached to the stomach and had formed a pouch, thus her spitting up since birth! We went to the hospital and I was blessed to have seen Joanne and Kayla just before surgery. That little 5.6 pounder was a fighter but I hated seeing her all tubed up! Joanne was doing so well for just having given birth, I was proud of the way she handled it all...with grace!
After 3 some hours of waiting, Kayla made it through surgery and was on her way for recuperation. She was supposed to be in the hospital for a month and that miracle baby was out in two weeks. I call her a miracle baby because we had heard of other babies born with the same problems who had longer hospital stays and who did not survive. According to the Doctor, there is a small window to perform the surgery and if it's not done then, life would be compromised! Kayla Rose is a happy, beautiful baby who survived and though she still deals with a feeding tube and doctor visits, it does not bring her down, she smiles with grace over her life!
***How did I miss this....Esophageal Atresia can be detected by ultrasound after 28 weeks, Joanne's last sono was at 22 weeks. Joanne's fundal height measured right on and sometimes under her weeks. What I thought I palpated as part of the baby's back was indeed all of it and what I thought was forehead was possibly her whole head! I had also palpated for fluid level wich had minimal thril.
***How was this a God thing: Had I caught this beforehand, we would have had to transfer Joanne out of care. Being in the hospital and having her labor stall with little progression would have caused a nurse to break water without the same caution , hence face presentaion would have occurred and Joanne would have likely had a c-section. With the problems arising, Kayla would have been transferred to Cooks and gone through surgery in one hospital while her mother was recovering at another! In our ignorance, Joanne was able to have her homebirth, spend a precious first few hours with her daughter without being tubed and tied to a NICU bed, and spent every moment with her daughter even just before and after a serious surgery.
Thank you, Lord for ignorance and the grace you showered us in this situation!
Monday, March 9, 2009
It's never TOO late!
So many people think that you once you have started care with a healthcare provider you have to finish your care with the same provider. I am not one of those people. Sure, I have taken women after 36 weeks and I have had my share of delivering a baby and then getting the woman's name, but that was at a high volume birth center. As of late, the birth center has been picking up in business and our number of births are climbing, so it hasn't been surprising that I have had many calls from women wanting to switch to our care at like 33, 29, even 37 weeks.
Last week we received a call from one woman who asked a bunch of questions and was given our information from a local childbirth educator. She had been in a class with another client of ours and the two of them shared a doula. I wasn't shocked that she called wondering if she should switch care cause her Nurse Midwife was wanting to induce because she was late. She had fibbed a lil bit on her Last Menstrual Period date so that the hopistal staff wouldn't be hostile if she was going to be late. We told her we could deliver her if she wanted to switch, but we didn't hear back from her. That is....until Friday evening at 5 pm.
After a long week, Melody and I decided to go pamper ourselves with a pedicure. As we were finishing up our pedicure, my phone rang. It was this woman and I handed the phone over to Melody. It wasn't 5 minutes before Melody was asking if we could go meet this woman and her husband later that night. Both of us had plans until late that night, but she was willing to meet with us even if it was midnight. She was scheduled for an induction at 9am the next morning. I was slightly hesitant but agreed. I mean she is healthy and all is normal, right? Well, as I was on my way to carry out my plans for the evening (around 7pm) Melody called to say that this woman was contracting every 4 minutes and that we should meet her now. Melody agreed to meet with her right away and let me know that I should turn around and head back. This was her first baby, so surely it would take all night. She had only begun to have regular contractions an hour before. I called her husband and said, "Hello, this is Venessa, I am the midwife." He answered with "Hi Venessa, the midwife." He handed the phone to the doula and she informed me that the couple had decided they wanted a home birth. My first thought, "Oh wow, here we go" and oh by the way her contractions were then every 2 - 4 minutes.
Melody called me 20 minutes later only to tell me that the woman was 5 cms and definitely huffing and puffing. So there went my plans out the window...off I went to the birth! I quickly rushed or sped while calling the students and walking them through directions on what to do and what to get from the birth center! Funny thing is that all my students had company from out of town and plans for the evening. They are learning fast that a midwife's plans are never definite :)
I walked in to meet her husband and finally introduced myself to the woman with "Hi, I am Venessa, your midwife." She said, "Hi I am ****** and this Alayna," as I was touching her belly. I showed up at 8:15 pm to find this woman acting "transitiony" and by 9pm she was 8-9 cm. I did find out however, that she had taken castor oil that morning as she was determined not to be induced! My whole birth team was there and we were ready (except for the fact that the only information we had on them was their first names). I did know she was group B negative and all her labs had been normal...phew!
She decided to get in and out of the water, but went right back in...she only had an anterior lip by 10 pm and gave slow pushes in the water. She struggled to push in the water so we moved her to the birth stool. She loved the stool and felt like she could control her pushing more. Her pushing was much more effective and all had been picture perfect. As soon as the baby was about to crown, her heart rate went down to 90 and did not recover...I held my breath and prayed. I knew it would be alright just because she was gonna be out in less than 20 minutes. With the next push, she made it to crown, but her heart was still slow. As her head came out, she restituted the wrong way, I tried to turn her head the right direction but she wasn't able to go that way. I merely waited until I could see the anterior shoulder. But before her shoulder I saw two hands crossed in front of her neck and I had already unwrapped the cord that was around her neck.
By this point, too much time passed so as soon as she was born, she flopped into daddy's hands, but I could not find her heart rate. Melody rushed to give her a breath and another one and another one. We put her on the floor to start resuscitation. She opened her eyes once. Mom and dad were talking to her the entire time and finally, a very slow 90 seconds later, she cried! Baby recovered and I was able to breathe again. She had passed a lot of meconium on the way out (which was a sign of her stress), but she pinked up and was in mama's arms in no time. Even through all those challenging moments, the birth was beautiful and the new parents were thrilled! We then began some of the paperwork and it wasn't until 36 hours later that I realized she was 43 weeks and 1 day on the day she delivered! YAY! She is now the latest one I have delivered and to top it off, it was a sweet and exciting birth! After it was all over, the birth team and I headed over to Denny's to regroup and debrief and what was written on the back of that menu? "It's never too late!" Yeah, you can say that again! :)
Last week we received a call from one woman who asked a bunch of questions and was given our information from a local childbirth educator. She had been in a class with another client of ours and the two of them shared a doula. I wasn't shocked that she called wondering if she should switch care cause her Nurse Midwife was wanting to induce because she was late. She had fibbed a lil bit on her Last Menstrual Period date so that the hopistal staff wouldn't be hostile if she was going to be late. We told her we could deliver her if she wanted to switch, but we didn't hear back from her. That is....until Friday evening at 5 pm.
After a long week, Melody and I decided to go pamper ourselves with a pedicure. As we were finishing up our pedicure, my phone rang. It was this woman and I handed the phone over to Melody. It wasn't 5 minutes before Melody was asking if we could go meet this woman and her husband later that night. Both of us had plans until late that night, but she was willing to meet with us even if it was midnight. She was scheduled for an induction at 9am the next morning. I was slightly hesitant but agreed. I mean she is healthy and all is normal, right? Well, as I was on my way to carry out my plans for the evening (around 7pm) Melody called to say that this woman was contracting every 4 minutes and that we should meet her now. Melody agreed to meet with her right away and let me know that I should turn around and head back. This was her first baby, so surely it would take all night. She had only begun to have regular contractions an hour before. I called her husband and said, "Hello, this is Venessa, I am the midwife." He answered with "Hi Venessa, the midwife." He handed the phone to the doula and she informed me that the couple had decided they wanted a home birth. My first thought, "Oh wow, here we go" and oh by the way her contractions were then every 2 - 4 minutes.
Melody called me 20 minutes later only to tell me that the woman was 5 cms and definitely huffing and puffing. So there went my plans out the window...off I went to the birth! I quickly rushed or sped while calling the students and walking them through directions on what to do and what to get from the birth center! Funny thing is that all my students had company from out of town and plans for the evening. They are learning fast that a midwife's plans are never definite :)
I walked in to meet her husband and finally introduced myself to the woman with "Hi, I am Venessa, your midwife." She said, "Hi I am ****** and this Alayna," as I was touching her belly. I showed up at 8:15 pm to find this woman acting "transitiony" and by 9pm she was 8-9 cm. I did find out however, that she had taken castor oil that morning as she was determined not to be induced! My whole birth team was there and we were ready (except for the fact that the only information we had on them was their first names). I did know she was group B negative and all her labs had been normal...phew!
She decided to get in and out of the water, but went right back in...she only had an anterior lip by 10 pm and gave slow pushes in the water. She struggled to push in the water so we moved her to the birth stool. She loved the stool and felt like she could control her pushing more. Her pushing was much more effective and all had been picture perfect. As soon as the baby was about to crown, her heart rate went down to 90 and did not recover...I held my breath and prayed. I knew it would be alright just because she was gonna be out in less than 20 minutes. With the next push, she made it to crown, but her heart was still slow. As her head came out, she restituted the wrong way, I tried to turn her head the right direction but she wasn't able to go that way. I merely waited until I could see the anterior shoulder. But before her shoulder I saw two hands crossed in front of her neck and I had already unwrapped the cord that was around her neck.
By this point, too much time passed so as soon as she was born, she flopped into daddy's hands, but I could not find her heart rate. Melody rushed to give her a breath and another one and another one. We put her on the floor to start resuscitation. She opened her eyes once. Mom and dad were talking to her the entire time and finally, a very slow 90 seconds later, she cried! Baby recovered and I was able to breathe again. She had passed a lot of meconium on the way out (which was a sign of her stress), but she pinked up and was in mama's arms in no time. Even through all those challenging moments, the birth was beautiful and the new parents were thrilled! We then began some of the paperwork and it wasn't until 36 hours later that I realized she was 43 weeks and 1 day on the day she delivered! YAY! She is now the latest one I have delivered and to top it off, it was a sweet and exciting birth! After it was all over, the birth team and I headed over to Denny's to regroup and debrief and what was written on the back of that menu? "It's never too late!" Yeah, you can say that again! :)
Sunday, February 8, 2009
"I AM FREAKING OUT"
Aw... the term "freaking out" normally used when one is losing control AND showing it...or not! On January 21, I had a client who was exactly 40 weeks. For whatever reason, I had a feeling she would have her baby that night. I called her around 7pm to ask how she was feeling. She responded with the normal...I am having contractions, of course not in any pattern and not too painful! She had sounded annoyed for the previous 3 weeks because she was so ready to "get the kid out"! But when I talked to her that night, she was so peaceful and calm....I teased and said that I wanted her to call me at 3 am just for the fun of it and myself, along with Melody and the students could do a drill. I wanted something to happen...time was nearing for other births and I was sweatin it and bored outta my mind :) She said she would call..."just for fun" and that she would talk to me later. I went on ahead to home and got some stuff done and had a very long devotions. I feel like I had a meeting with God that night about many things and I stayed up until 1:30 am ...hmm It wouldn't have so bad if I could have slept in ...oh but no, my phone rang at 2 am and it was my client calling that her water had broken just 30 min before. I tried to get her to lay and rest, but then a contraction hit her on the phone and I immediately knew, I needed to leave. I hung up the phone and alerted the "birth team". When I was on my way to her house, I had called back to let her know, and she was telling me how quickly they were coming. I stayed on the phone with Melody while we were meeting at our client's house...partly to keep focused and awake (I had only had 30 minutes of sleep) and also to pray for the birth as we always do. It was incredible the timing of ALL our arrivals. I showed up first with Melody and Rose Mary 3 minutes behind me, Joni, 10 minutes after that and very shortly after, our client's doula showed up. I was greeted at the door by "Daddy" and his first response was "WHOA you are already here...she's in the back"!! I went down the hallway to find my client just out of the shower standing and leaning on the wall. The first thing she said to me in a very quiet and calm tone was "I am freaking out!" It was so hard not to laugh just because her behavior and actions did not match. I reassured her that she was doing great and as Melody walked in the room, all she could do was repeat how much she was freaking out. I asked her if she wanted to get on the birth stool , lay down, or get in the tub..she dropped to the floor on hands and knees and repeated calmly that she was freaking out and how she wished she would stop! I couldn't believe it, she was perfectly calm and you couldn't even tell she was contracting. I put her on the birth stool and did a 3 minute read. I really don't think the baby was liking her position because her heart rate was dipping which seemed unusual for where she was in labor (6cms). As soon as we changed her position and put her on hands and knee, Baby was alright with everything and was happy with her position. I never really heard much more than a groan and oh S*** once. I asked if she wanted to get in the tub and she finally made her way there. It was in the tub where things got really QUIET. She had been wanting to do hypno-birthing, but her husband wasn't %100 on board so she figured she would do bradley again...this was NOT bradley. Once in the tub, she totally drew back inside herself and you couldn't even hear her breathe, much less have a contraction. I kept finding myself mouthing to my student asking if she was still contracting? Then it happened ...TRANSITION! Her silence went to deep groaning. I asked her what she was feeling. Her husband replied, "Pain, she feels lots of pain, don't worry, honey, I answered her for you" She doesn't remember him saying that but I wanted to wring his neck :P He began to chuckle....he was so supportive and good to her. A few minutes passed and I asked where she was feeling her pain? She replied with "between my butt and my T***!" She didn't say much but what was said was very colorful :) ! She was a hoot! Anyhow, she felt pushy and started to do so...the only thing was her position and the water level was a bad combination. Either she needed to get in or out...she told me she was not moving! Therefore, we drained the tub and proceeded to push. In no time flat baby JamieAnn was born at 5:22 am. She was born with her hands up by her chin and a long cord that got wrapped up with mom's leg as she turned to grab her baby! Just before she came, friends, grandma, and big sister were all there to welcome her arrival. It was a very sweet birth. Mom and baby stayed in the tub until they were done with their bath. Postpartum went by quickly and as the sun was rising, mom was getting into bed to finally snuggle with her baby girl. In retrospect , I have to say that this was one of the most calm and quiet births I have attended. At her first postpartum visit, my client felt that she was out of control and freaking out the entire time. Then she realized she drew so far into herself that she didn't remember her labor or delivery, hence me writing about her birth story. I can only dream of my birth when I can "FREAK OUT" just as she did.
**note ** My client requested I write this for her and I thank her for allowing me to share this special birth on this blog!
**note ** My client requested I write this for her and I thank her for allowing me to share this special birth on this blog!
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