Empowering Birth Blog

Carey's VBAC

Thank's for sharing your story Carey!

Benaiah’s birth

Big Ben was born on Thursday August 2, 2007 at National Naval Medical Center.  That is not how we planned it to happen, but babies have an agenda of their own and the mother has to go along with that. 

Early labor started on Tuesday evening about 10 p.m.  I had experienced labor before so I knew that I had a long way to go so I went to sleep until about 4 a.m. when contractions started to pick up.  I called my midwife, Karen, at 5 a.m. when my contractions were around 5-6 minutes apart.  She called her birth assistant, Nicole who showed up about half an hour later.  She checked my progress and I was 50% effaced, 3 cm dilated at a zero station.  She told me to try to get some rest and to call her when I needed her to come back.  Around 8 a.m. contractions picked up more so I called my doula, Kat.  Both she and Nicole arrived between 8-9 a.m. and we sat around chatting while I crocheted Ben’s baby blanket.  I was having a wonderful time with my friends and enjoyed the conversation.  My mom took two year old Eve to the park to give me a little time to relax and my husband time to set up the labor pool in the living room.  Labor was progressing very slowly and by the noon, Kat had me walking the hallways in my building.  During contractions, she would press a warm, lavender scented rice sock on my lower back that felt wonderful.  I also used the sock on my lower abdomen while we walked.  The walking really seemed to intensify and speed up the contractions, but they were still very manageable.  I sat on the birth ball and circled my hips too, which was a comfortable position.  Nicole checked my progress and this time I was 80% effaced, 4-5 cm dilated at a zero station.  Kat suggested that my husband and I spend some time alone together, which was a great idea.  We talked, kissed, danced, and enjoyed each other’s company and before long labor picked up again.  He did a fantastic job supporting and coaching me and would rub my back through contractions while I stood with my hands on the wall above my head.  We spent about two hours doing this before Kat, Karen, and Nicole showed up together in the early evening.  Thomas needed a little break so I took my birthing ball with me into my closet for some quiet time.  I was able to relax and concentrate only on my contractions and it made me understand how helpful meditation or yoga can be during labor.  From time to time, someone would walk into my closet to check on me and see that I was doing fine.  Everyone seemed pleased with the progress, and I knew the baby would be born that evening. 

Karen and I decided to check my progress and sure enough I was about 7-8 cm dilated, but the baby was still a little high.  She said the baby’s head was slightly to one side so I should do some exercises to open my pelvis so the baby’s could move down.  We set up a chair while I did placed one foot on the chair and did a squat 10 times before switching feet.  We did this exercise for an hour or two and seemed to move the baby to a better position.  I tried the exercise ball again at this point, but the labor was still not moving forward as it should.  There was a bag of water and a cervical lip preventing the baby from dropping further in to my pelvis. Karen decided to break the bag of water that was in front of the baby’s head and as soon as she did, contractions started getting a lot more intense.  The feeling during this time was of helplessness, with contractions on top of each other.  All you can do is try to get through each contraction.  Your body is working so hard and breathing and letting your body relax are about the only things you can do.  I tried every position that was suggested by Kat, Nicole, and Karen and found the best were sitting on the toilet and standing in my bedroom with my hands on the wall above my head.  I couldn’t get on my hands and knees or squat while holding on to anything.  Kat, Nicole, and Thomas took turns supporting me and applying pressure to my hips from both sides.  It was a tremendous relief to have them push on my hips and I know they were all exhausted from the work.  After some time in this phase, Karen decided to check on the cervical lip again and it was still present, but I was 100% effaced, but my cervix was swelling a little bit and I was experiencing some intense back pain.  Everyone was so encouraging telling me that the back pain was normal and it was because the baby was moving down.  Karen suggested I get into the labor pool to try to relax a little.  It was such a relief that my contractions slowed down.  I would fall asleep after a contraction and wake up at the peak of the next grasping for Thomas’ arm.  The girls brought in the birthing stool, but there was too much pain in my back to sit on it and I still didn’t feel like pushing.  After about an hour and a half I got myself out of the tub to get checked again.  I was still not fully dilated and the cervical lip was still there but the baby had moved down some.  It was encouraging and frustrating at the same time.  I tried taking a shower and squatting on the toilet, but the back pain was taking over and I was reaching a point of total exhaustion.  When Karen said there were some heart decelerations I started to worry a little and we decided that I should go in to the hospital.  Nicole drove Thomas and I in and we arrived about 4 a.m. to the Emergency Room at NNMC. 

The drive was long and Thomas rubbed my shoulders while Nicole gave a pep talk.  The doctor checked my progress in the ER and I was fully dilated and the cervical lip had disappeared.  They kept telling me I was ready to push, but I could hardly talk or think, let alone push.  They got me to a room and after much discussion with my doula, we decided to try a local shot to relieve some of the pain in my lower back.  They had me pushing on my back for an hour with three pushes during every contraction and then they brought in the squat bar and I pushed for another hour making very little progress.  I could see the concern on everyone’s face.  The doctor and I decided that I could receive a two-hour spinal and after an hour of rest I would begin pushing again.  Nicole was very hesitant, but knew that I something had to be done.  She told me that if I received the spinal that I had to wake up and push the baby out.  After I received the shot, Nicole and I fell asleep while Thomas went to get some coffee.  Thirty minutes later I woke up and could feel the pressure of the contractions again and felt like pushing.  Nicole, Thomas, and the nurse helped me sit upright in my bed.  The first hour of pushing I didn’t feel much pain, and was making slightly better progress.  When the spinal wore off, the backpressure returned and that is when things actually started happening.  The next hour of pushing was totally different, because I could actually feel the baby moving down and back up with each contraction.  Nicole and Thomas were wonderful coaches and kept telling me that each push was moving the baby a little more.  The nurse essentially stepped aside during contractions and Nicole coached me through them.  When Nicole told me I could touch the baby’s head, everything changed.  Just the soft feel of the baby’s head was what I needed for the extra motivation to get the baby into my arms.  The feeling of the baby’s head crowning was a very sharp burning pain and when I would say it burned, Nicole would nod and say she knew it did.  I felt like screaming but the only way to push was to use a low moan.  The OB arrived ready to catch the baby.  After three more contractions, the baby’s head was out, but the OB wanted me to push between the next contractions because the baby’s shoulders were stuck.  She used her fingers to pull the baby out under his arms and in no time he was crying on my chest.  At that point I was so relieved and totally exhausted that Thomas took the baby to get weighed and measured.  Nicole brought me crackers with peanut butter, Jell-O, cereal, and juice and my lovely husband brought me a mirror.  I had no idea, but my eyes were almost swollen shut and both my eyes were totally bloodshot from all the pushing.  I looked scary, but it made everyone in the room laugh out loud.  My husband told me later on that had Nicole not been in the delivery room, we would have ended up with another cesarean.

Benaiah Maxwell was born at 7:50 a.m. and was 9 pounds, 1 ounce and 21 1/2 inches long. 

Looking back, I realize that I had some issues that weren’t fully resolved from my previous birth experience that ended in a cesarean.  I knew I had to surround myself with people that fully believed in VBAC.  My doula could not have been more perfect having had a HBAC herself and knowing what an empowering experience that is.  My midwife had a VBAC as well and never gave me any doubts as to whether a VBAC was right for me.  My labor stalled at the same point as the first birth, but all it took was the love and support of those around me to move past it.  Although I had planned a home birth, I am extremely pleased with how things turned out.  The 40-minute car ride to the hospital gave me time to clear my head of the frustrations that were present and allowed my body to open up in order to give birth.  It takes absolute concentration to push and because I was so exhausted, there was no way my body was going to cooperate without getting a little rest first.  All it took was a 30-minute nap before I could push my baby out.  There is no way I could have had a VBAC without laboring at home for so long, and there is no way I could have gone through such a long labor without the loving and steady support of Thomas, Kat, Nicole, and Karen.

Happy Birthday Fenimore!

Two years ago today I had my first VBAC.  It is 7:32 am so Fenimore was already a little over three hours old and snuggled up asleep, wrapped tightly in our bed with yellow flannel sheets.

There are times when, in my naivety, I truly believe that anyone with a bit of desire and a good doula can have a VBAC.  My friends remind me that I worked my butt off to have a VBAC, and indeed I did.  In the end it seemed easy because the work paid off and the birth went so smoothly.  I was so ecstatic, singing throughout the birth, smiling between contractions, so happy to know my body worked, that I would soon hold my baby in my hands.  To this day, focused thoughts on the birth bring tears to my eyes.

But the months before were full of meditation and yoga (lots of hip-openers), no matter how tired I was I woke up and sat on that mat to meditate.  I carefully researched my hospital records to understand exactly what went wrong the first time and talked the head labor and delivery nurse into reviewing my records and giving me her thoughts on what happened (she thought they probably decided I was too tired to push the baby out and the doctor was getting antsy).  My chart stated that my cesarean was for reasons of CPD.  This was the first time I had seen that word, I had no idea I had had a cesarean for CPD.  True CPD is rare and I just couldn't believe my case had been a true case of CPD.  At the same time, it took a LOT of work to squash those nagging doubts installed by the experts, "maybe my pelvis is too small...."

But I covered a lot of ground in those nine months and as my due date approached, I was ready!  Happy Birthday Fenimore, thank you for helping me renew my faith in my body.

Midwives Rising

Tonight I hosted a screening of The Business of Being Born.  I was a bit worried about attendance.  Given my constant nausea, exhaustion, and severe pregnancy brain (I actually forgot to introduce the organization that will receive the proceeds from tonight's showing), this wasn't the most spectacularly planned event, and yet we had a good fifty people in attendance!  It was a family-friendly, casual showing that brought together many pregnant moms, doulas, midwives, even an OB (a friend of mine who LOVED the movie by the way).  Everyone seemed to enjoy the movie (and the pizza) and we had a lively conversation for a good hour afterwards.

I feel as though there is a midwifery movement afoot.  Not only do I know quite a few people studying to be Certified Professional Midwives in the area but there is a group discussing the formation of a new birth center, a midwife who has started her own private practice associated with a local hospital, talk of a midwifery practice moving into another local hospital AND several Certified Midwives who lost their job when a local birth center closed and a local doctor practiced let their midwives go are now attending the home births of local women.  There was a lot of good energy in the room tonight.  Let's go out there and put normal birth back in the hands of midwives.  Tonight I am full of hope, may I keep this hope in my heart when things get tough.

A New VBAC Blog!

There is a new VBAC blog out there.  Join this mom on her journey to a VBAC and send her lots of good energy!  With a lot of work and strong support, I am sure you will have your VBAC.

Squatting

Yoga is extremely beneficial during pregnancy.  One particularly helpful pose is the squat.  Practice squatting in the beginning of pregnancy so that you can build up leg strength and so the squatting position becomes natural to your body.  If your heels don't reach the ground, either place a rolled up blanket under your heels (bring the floor to you) or spread your feet wider apart with your toes pointing more out towards the sides rather then directly in front of you.  It is important that your heels are touching the earth (or a blanket) so that your pelvic floor muscles can relax.  Practice squatting regularly so that you can hold it for two minutes.  That way you will be able to hold the squat, even through a super-long contraction.

If you must get the epidural...

wait until you've had one normal vaginal birth.  Once you've popped a baby out, your body knows the ropes, you don't have all that first time mom (or VBACing) anxiety and so you won't have to stress so much about the whole epidural, pitocin, more pitocin, baby in distress due to pitocin, c-section cycle.  If you don't try it once, you will never know what you are missing.  I know, there are so many stories out there about how epidurals are wonderful, but that is only because there is such a SMALL percentage of the population out there experiencing normal birth.  I was just discussing normal birth vs. medicated birth with a fellow mom and the lack of incentive for a normal birth because it almost seems myth-like.  Moms read about it in books but don't know anyone who has actually had one.  This mom had an out-of-body experience giving birth that was WILD. How do you share the power of a birth that is beyond words?  And what impact does your story have when the mom who hears it has heard 100 stories of medicated births to your one story of normal birth.  So if you are considering the epidural, why not choose it after your body has learned the rhythm of birth (and try and make it to 7 centimeters).*  And normal birthing moms, we HAVE to share our stories!

*If you opt for the epidural for medical reasons or other, waiting until your body is fully in active labor and assuring that baby is in a good position for birth will help you avoid unnecessary interventions. Studies looking at the link between early epidurals and cesarean delivery report a higher rate of cesarean delivery with earlier epidural.1

1 Ellice Lieberman, MD, DrPH and Carol O'Donoghue, MPH,MSN. "Unintended effects of epidural analgesia during labor: A systematic review" in The Nature and Management of Labor Pain: Peer-Reviewed Papers from An Evidenced-Based Symposium, edited by Judith P. Rooks, Carol Sakala, and Maureen Corry, Supplement to American Journal of Obstetrics and Gynecology (New York: Mosby, Inc. 2002).

Better Ways to Push

Quoting from my Myles Midwifery textbook (hmm, do doctors not learn this stuff?), pg. 3261:

Prolonged pushing with held breath such as the Valsalva manoeuvre, which is undesirable for healthy woman, may be dangerous for a woman with heart disease.  It raises the intrathoracic pressure, pushes the blood out of the thorax and impedes venous return, with the result that cardiac output falls.

So WHY do I see this kind of pushing at most of the hospital births that I attend?

And while we are on the subject of pushing, even before I started doing a lot of research on the subject, my intuition suggested that severe tears must be affected by position and epidurals in particular.  In a recent article*, anal tears were more common in moms delivering in the lithotomy position and squatting.   The study's author, Dr. Karin Gottvall from the Karolinska Institute, Stockholm, Sweden, explored the role of maternal position in the second stage of labor as a risk factor for anal sphincter tears. Nearly 13,000 women were included in the study. "The lithotomy position was also associated with postmaturity, induction of labor, use of epidural anesthesia (italics mine), prolonged second stage of labor, episiotomy, low Apgar score at 1 minute, and infant birthweight over 4000 g, the report indicates."2

I can understand the propensity to tear in the squatting position.  Squatting is a great position to labor in but it takes full advantage of gravity which can speed things along. When baby is crowning, speeding things along is NOT a good way to avoid tears.  It is also harder to rest between pushes when squatting and can therefore be difficult to take things slowly. 

*If this link doesn't work for you, google Dr. Karin Gottvall and birthing position and this should take you to the link.

1Diane M. Fraser and Margaret A. Cooper, Eds. Myles Textbook for Midwives (London: Churchill Livingstone, 2003) 326.

2Mother's Birthing Position Affects Risk of Anal Sphincter Tears, Reuters Health Information, 2007, http://www.medscape.com/viewarticle/563937?src=rss, accessed October, 23, 2007.

Learning to Trust your Body

It isn't easy.  As women we are trained not to trust our intuition.  I am reading a great book, Women's Sexual Passages by Elizabeth Davis.  Lots of good info on our culture's impact on womens' sexuality.  Growing up as a Catholic School girl, I could tell you all about repressed sexuality, let me tell you.  But this doubting of our bodies seeps insidiously into adulthood and pregnancy.  I've done a lot of work and thought I've moved past those nagging doubts but a simple pregnancy test unearthed them. 

I first suspected I might be pregnant the day my period was due.  My husband, excited by the prospect, suggested we take a pregnancy test.  The line on our last pregnancy test that indicates you are pregnant was almost invisible.  I thought my eyes might be playing tricks on me.  Was there really a line?  I wasn't sure.  For the next five-six weeks or so I would wonder from time to time if I was indeed pregnant.  I was nauseous, I had not yet had my period, I had strange food cravings, and even harder to ignore, I was dog-tired, every bone in my body ached with exhaustion.  And yet I had that little nagging voice repeating, well, you never really had a definitive pregnancy test.   I came very close to running to the CVS several times but managed to keep my doubts under control.  At 11 weeks, my belly poking out slightly, I no longer doubt that I am pregnant but marvel that it took me so many weeks to kill those doubts.  Ah ladies, how many times do we let "science" or what the "experts" say squash the voice of intuition.

First Home Visit!

The best part about working with a Certified Professional Midwife is the home visit!  My midwife doesn't do many home visits anymore as her practice is rather large, but I still get the occasional home visit, this one from her apprentice of close to two years who is also a good friend of mine.  Nicole took my blood and did a pap smear (because it has been about two years since I have had one), all in the comfort of my own home.  Khady has been practicing taking my blood since Nicole left.  It is so good for her to see mom taking charge of her own health and this means not always having to run to the doctor.  I wanted early blood work because I am RH- and wanted an anti-body titer.  You can debate the pros and cons of Rhogam until the cows come home but when you come from a family that has lost many babies to blood incompatibility, you don't mess around.  Funny how the women in my family continually marry men with positive blood.  I don't get Rhogam  prophylactically but I do check for antibodies and I take Rhogam immediately if I have any bleeding.

An Intense Week at The Farm

The seven midwives that teach at the Farm are:
Ina May Gaskin, CPM
Pamela Hunt, CPM
Joanne Santana, RN, CPM
Carol Nelson, CPM
Deborah Flowers, RN, CPM
Stacie Hunt, CPM
Jeanne Madrid, CPM

If you have a copy of Spiritual Midwifery, turn to page nine and you will see pictures of Ina May, Pamela, Carol, Deborah, and Joanna.  Stacie Hunt is Pamela Hunt's daughter-in-law.  Jeanne Madrid shared her story of Mulci's birth from Ina May's Guide to Childbirth (pg. 74).  Seeing these women in person, after having read their stories, and reread their stories, was like seeing a super-hero come to life.

The list of topics covered in full:

• The role of the midwife assistant
• Basic sterile technique, packing and sterilizing instruments, and drawing up injections for suturing
• Anatomy and physiology of female reproduction
• Introduction to midwife assistant skills
• Baby's position, station, engagement, dilation checks (using both pregnant women and extremely life-like models)
• Introduction to charting, record keeping and medical terminology
• Oxygen set up and use
• Midwife assistant's role in postpartum care of the mother: fetal circulation, immediate postpartum care, cord clamping technique, collecting cord blood
• Introduction to newborn assessment and postpartum care of the baby and Apgar scoring
• History of midwifery
• History of The Farm Midwifery Center
• Breastfeeding tips for the midwife assistant
• Cultural differences in childbirth education
• Care of the laboring woman
• Bloodborn pathogens and the midwife, OSHA/ARC standards
• NARM certification: what it is and what is involved in becoming a CPM

What I've been thinking about since I've been back:

• I need to take better precautions about protecting myself and family from possible germs picked up at births.  Things I need to do: purchase eye glasses to protect my eyes, throw crocs in a bucket of bleach when I get home, etc. etc.
• Vitamin K....  I haven't been very pro vitamin K but two babies on The Farm were born with Vitamin K bleeding deficiency disease and now they offer vitamin K at birth.  Oral Vitamin K sounds pretty harmless and I also learned that (according to Diseases of the Newborn by Shaffer and Avery) in a 20 year study done at Johns Hopkins where the mothers were given 1cc before birth, there were no cases of hemorragic disease of the newborn.  Certainly seems harmless to give mom a shot of Vitamin K before the birth.
• Rhogam.  I think I just might offer a shot to all Rh- moms after the birth.  Those little blood-typing cards don't always work and I come from a family that lost A LOT of babies to blood incompatibility.  This might be one of those cases where the benefits, especially when given after birth, out-weigh the minute risks.  Of course a mom can always decline.
• I have SO much to learn.  I mean, I already knew this, but sometimes I get the impression that people think that midwives read a few books and then go out there and catch babies.  Well, I am sure some do but the majority spend A LOT of time on their education and their knowledge base is extensive.  I want to know my stuff through and through and it is going to take several more years for me to get there.  I must keep reminding myself that there is no rush.  If all goes well, I should be a midwife in about 5 years?  That includes two years without attending births once baby number three is born.