Thursday, August 21, 2014

What Constitutes an Emergency?!


This lovely lady is one of my all time favorite people.  (Doesn't she look great resting her belly on my countertop?!)  Our husbands have been best friends since grade school, so when we all got married, the 4 of us quickly became inseparable.  I was able to support Emily during the birth of her 4th child a little over 5 years ago.  Even though her son had spina bifida, she was able to have a completely intervention-free birth.  We were planning on the same for this baby....

We were a little wrong.  

Due to low amniotic fluid, Emily was scheduled for an induction early in the morning on August 20th.  But when she arrived, they discovered that her baby was breech!  The doctor immediately suggest an emergency cesarean.  Wait, what?

Emergency?

This baby was not in distress, nor was this woman in labor.  I'm really struggling to see the emergency in this scenario, so I'm going to say this doctor either really over reacted, or just really loves doing cesareans....

Thankfully, the anesthesiologist would not allow the cesarean for 6 hours because Emily had eaten breakfast.  So since this wasn't a really emergency, and there was quite a bit of risk involved in doing a cesarean after a meal, Emily and her husband were given til 1:00 pm to turn their baby.  When the doctor came back at 1:00, their little guy was soooooo close to being head down.  Reluctantly, the doctor helped her baby get in head down position.  

It took about 45 seconds.  
FORTY-FIVE seconds determined the type of birth she would have.  Wow.

Pitocin was administered immediately, and we all did everything we could think of to keep that little boy head down.  Contractions were very mild at first, and didn't start becoming difficult until about 4:00 pm.  The contractions were 2 to 3 minutes apart the entire time.  That doesn't give mom much time to rest, but Emily was handling them wonderfully!  

 At 5:20, Emily was dilated 3 cm, which was progress from the 1 cm she was at that morning.  But her baby was still not engaging in the pelvis.  She labored on the ball, walked, and squatted throughout.  

8:00 pm, 5 cm!  Definitely progress, but baby was still high.




Emily utilized music and relaxation throughout her birth.  She swayed in tempo, and tapped her fingers to the beat.  


Around 9:00 pm Emily's contractions were very intense.  I rolled a rolling pin filled with ice water up and down her back.  This trick is a dream come true.  I use it all the time, and had it used on me during my births.  


At 11:00 pm, Emily was still only 5 cm, and head was still not engaged.  This is when discouragement really kicks in for moms.  Contractions that are strong but not doing anything are super hard to cope with!  
At 11:30 Emily received an epidural, and we all settled in for a nap.  I assumed she would sleep all night, but I was so wrong!
By 1:45 Emily was dilated to 7 cm and her baby's head had finally descended into the birth canal!  Throw in a little vomit, a few pushes, a cord wrapped around his neck, and one tug from the vacuum, and this little cutie was finally born!


Thursday, August 21st, 2014
2:15 am
7 pounds 13 ounces

Sunday, May 18, 2014

Shoulder Dystocia


My phone rang at 3:20 this morning, and I knew I needed to hurry.  Baby #2 for my client was on his way, and her first birth went fairly quickly.  I arrived at the hospital shortly before 4:00 am and found mom laboring beautifully.  I couldn't even tell when she was having contractions, but she was already dilated 6 cm!  I knew she would progress quickly, and after about 30 minutes I could tell when she was contracting only because she would breath a little louder!  She was so relaxed and focused.  

She began to have the urge to push around 5:10 am.  The midwife checked her cervix and she was complete.  The midwife decided to break the bag of waters, and the urge to push subsided for several contractions.  By 5:30, mom was pushing, and pushing, and pushing.  But baby boy was coming down the birth canal slowly, and after a few minutes it was clear to see that he had shoulder dystocia.  


Situations like these can feel very stressful at the time.  Though in reality, it only took about 15 minutes for this baby to be delivered, each minute feels long when you don't see the progress you expect.  Mom had to work incredibly hard at the end to expel enough strength and energy to deliver her child.  And once he was out just enough, we could see that he was also very wrapped in the umbilical cord.  He was pretty shell shocked, and was quickly whisked to the baby nurses to help him with his crying and newborn reflexes.  


Daddy went over to talk to his new son, and this little guy pinked right up and was opening his eyes.  There was initial concern that there could be some nerve damage in his neck (from the shoulder dystocia during the delivery) since we wasn't moving his right arm at all.  But after several minutes, both arms were moving and he looked great!


What a cutie!


Welcome Reuben!
Born May 18th, 2014
5:41 am
7 pounds 14 ounces



At 6:10 am, mom and baby were finally able to snuggle.  



Little Reuben snuggled right into his mom, and you could tell that he was right where he wanted to be.  


Thank you for sharing your birth!

Monday, March 17, 2014

St. Patty's Day Baby!

When I first interviewed with this couple, they mentioned how fun it would be to have a St. Patrick's Day baby, and they got one!  (We'll see if green cupcakes are as fun as green beer....)  :)

Shortly before I went to bed on Saturday night, I received a text saying that mom was having mild contractions.  I woke up early Sunday morning to a text saying contractions had been going steady since 3:00 am, and by 10:00 am, mom was admitted to the hospital at 4 cm dilated and 95% effaced.

Knowing that first time moms often have long labors, I settled in for the long day, but was still optimistic that things would progress quickly.  They didn't.  I am totally blown away by how strong this couple, and their "Little" guy were!

This mom was not only in control-focused- and relaxed, but she was willing to try anything.  We walked the halls (in her super-cute labor robe), labored in the tub, and swayed on the birth ball.  The hours clicked away and her sense of humor and optimism stayed in tact almost as long as her bag of waters did!


At 5:00 pm mom was dilated to 6 cm.  Slow progress... but progress is progress!  We kept going with walking, swaying, squatting, listening to music, and massage.  Mom even mentioned that she felt like a queen as I rubbed her feed and her husband fed her ice chips.  At 7:30, her own mother stopped by to offer encouragement.  The feelings of love were so intense, that all of us teared up!  Giving birth sure brings out the emotions, and it was great to see the support this woman had in her life.

The hours continued, and at 11:00 pm, mom was still dilated to 6 cm.  News like this is incredibly frustrating and discouraging, especially once night time rolls around and exhaustion sets in.  This mom was visibly upset, as any woman would be.  But instead of giving up, she opted to allow the doctor to break her bag of waters, and we were all more determined than ever to get this baby out.


Mom's back began to hurt pretty intensely, and we all suspected that her baby was posterior (facing the wrong way in the pelvis).  This causes extra discomfort, and slows down labor (and for some reason, about 80% of my clients have had posterior babies in the last year!).  We added in the ice rolling pin for comfort, and mom started squatting and changing position often to encourage her baby to descend.  Dad offered physical support, encouragement, and always knew what to say.  They were an amazing team.

Finally, at 1:00 am we got news of progress; almost 8 cm dilated!  Mom was tired, but now had the encouraging news of progress.  She opted for nitreous oxide as a form of pain relief.  This is a new option at St. Lukes downtown, and this is the first time I have seen it be used.  It appears too good to be true, as the medical staff claimed it had zero risks and side effects.  But it worked!  Mom liked it because it was just enough to get her over the edge and make things manageable.  I liked it because it didn't affect the baby, and mom was still able to talk and change positions.  I can think of many women over the years who would have loved a pain management tool like this.  Women who desired to stay away from the well-known risks of epidurals, but also struggled with long labors.  I'll definitely be doing my homework on this new option.

 At 2:35 am mom was complete and ready to push.  Pushing can take a while with a first time mom, and this mom really found her inner strength.  Her endurance was amazing.  By now she had been up and laboring for 23 1/2 hours!


 At 4:45 am, "Little" Leprechaun Liam slipped in to the world, 
and almost broke the scale at a whopping 9 pounds, 15 ounces!  HELLO!







Dad was so proud, and I think he smiled for about an hour straight.  I just love to see dads like this.  (Partly because they remind me of my awesome husband, and partly because I can tell that they really understand the importance of family.)  These two love-birds sure are lucky to have found each other!




This birth had a great outcome, but it wasn't easy.  There were times that even I began to wonder if it would end in a vaginal birth.  I have seen many births with slow progress, and often they end in cesarean.  This birth was a great reminder to me to always trust a woman's ability to birth her child.  It was long.  It was hard.  But it was doable.  Women are capable and babies are resilient.

Wednesday, February 5, 2014

Fear vs. Faith

Since birth is unpredictable, there will always be some amount of fear concerning it.  But lately I have really noticed how so few care providers actually have faith in birth.  This lack of faith makes parents feel more fearful; and often, more willing to accept interventions that are offered to them without true medical need.  It's a cycle that desperately needs to stop.  

My latest client was expecting her third child.  She had been induced for medical reasons with both of her previous births, and was thrilled when this pregnancy had no medical issues.  For once, she was going to be able to go into labor all on her own!  

However, several weeks before her due date, her care provider kept finding things to fear.  The baby wasn't descended in the pelvis yet, or the heart rate was a few beats too low.  She talked often of the size of the baby, and worried it would be too large to be delivered vaginally (even though this mom had already vaginally delivered a baby barely under TEN pounds!).  The topic of cesarean came up at every appointment during the last 4 weeks of this woman's pregnancy.  

Where was the faith in this woman's ability to give birth?
She had already proven that she could, TWICE!  

Yesterday she was getting serious pressure to induce.  She and I spoke on the phone about the pros and cons.  This is a hard place for a doula, since we can't let our opinions sway the way we talk to our clients about their own agency.  But personally, I didn't see any true need to induce.  However, many couples agree to inductions because they feel that once the provider has mentioned it, that it is something they have to do.  Thankfully, this couple decided to go home and think about it.  And wouldn't you know, she went into labor that night!  

I received a text at 5:40 am, saying that contractions had just gotten intense.  Mom and dad arrive shortly before 6:00, and I got there shortly before 6:30.  I could hear mom vocalizing as I was walking into the maternity center, and I could tell she was about to have a baby within minutes!  

A fast labor is mainly a blessing, but can feel like a curse while you are experiencing it.  There are literally NO breaks.  Moms feel very overwhelmed, and often hyperventilate because it is so hard to find time to breath.  I quickly started helping mom find her focus, and use her breath purposely.  

Before the first official push, mom expressed her fear that the baby was too big.  Hmm... I wonder why she worried that.  Oh wait, it's because her provider planted that seed of fear weeks ago....



But there was nothing to fear, as her son was quickly born after just a few pushes!  
He came out a little blue, and a little lethargic; but had pinked up within a few minutes.  



No Name Baby Boy :)
Born February 5th, 2014
6: 47 am
9 pounds 5 ounces



Dad was able to hold baby while mom recovered.  
I could hear him talking and humming, and it was beyond sweet!  


Congratulations to a wonderful family, who truly had nothing to fear.  :)

Friday, January 31, 2014

I met my most recent client walking into church several weeks ago.  I asked her when she was due... One question led to another, and before we knew it, we were skipping Sunday School to talk birth.  I think we both felt an instant connection, and I was so excited when she asked me to be her doula!

During "Sunday School", this mom told me all about her first birth.  She was induced due to low amniotic fluid.  After contracting for over 24 hours, she only dilated 3cm, and had a cesarean.  Needless to say, it wasn't a great experience.  Her desire was to have a VBAC with her second child.  

Avoiding induction is key for a successful birth, especially a VBAC.  So I was thrilled when I woke up Thursday morning to a text saying she was in early labor.  She had an OB appointment at 1 pm, and was dilated 2 cm.  She arrived at the hospital at 6 pm, and was 3 cm.  Her contractions were very close together, and appeared to be quite strong, but they wouldn't admit her until she was 4 cm.


She labored quite a while in triage, and spent about an hour in the tub.  During this time I looked down and noticed her mucous plug was sitting right there... on my pants!  There's a first time for everything.  :)  

At 10 pm she was finally admitted, and was 5 cm by 11:15 pm.  

The contractions never eased up.  They were constant, which makes labor so much harder to cope with.  She was amazing!  By 1:00 am, mom was ready for sleep though, and received an epidural.  

Her OB came in around 8:00 am, and she was only dilated to 6 cm!  Not exactly what you would expect from a woman having contractions every 3 minutes for about 15 hours.  He broke her water, in the hopes it would help push her over this hump.  

But it didn't.

As the day went by, it was clear to see that no more dilation was going to take place.  Her baby was floating too high, and never engaged in the pelvis.  This prevented the pressure needed to push against the cervix and cause change.  A birth like this can be discouraging.  It is hard when you do everything right, and still don't get the birth you want.  But this mom doesn't have any "what ifs", like she did with her first birth.  She knows there was nothing else she could do, and that brings about a true peace of mind.


 

Baby Girl Remy
Born Friday, January 31st, 2014
5:38 pm
8 pounds 11 ounces



Tuesday, December 31, 2013

Squeezing In One Last Birth for 2013

I received a text at 5:20 am yesterday morning, saying my client's water had broken.  We kept in touch throughout the day, but her contractions never picked up.  We both went to bed surprised that she was still pregnant.  But at 4:00 am this morning, it was clear that she would be meeting her baby boy in the very near future.  I arrived at their home about 4:45, and found mom and dad working together and coping well.  

Mom was very instinctual, and spent her contractions leaning over and breathing deeply.  After an hour we were ready to head to the birth center.  


Dad helping mom into her slippers, getting ready to leave!


Mom was looking forward to laboring in the tub.  At 6:30 am, she was dilated to an 8, and decided to finish out her labor in the water.  


She continued to breath deeply until the urge to push was too strong.  
And at 7:13 am, 12/31/13, this cutie pie slipped into the world (and into the tub).  





Look at that perfect face!


By 7:40, this little guy was already nursing like a champ.


What a WONDERFUL way to finish off 2013.  I know this family is excited to ring in the new year with 3 sons tonight!

Saturday, December 28, 2013

There's a Fine Line....

It's hard to know when your reaction goes from a true reaction, to an over reaction.  As a doula, it's not my place, or my specialty, to make that call.  However, at the birth I attended tonight, I couldn't help but feel that there was much over reacting going on!  

My latest couple is a military family that recently landed in Boise.  This was their 3rd pregnancy, and the first time she went into labor on her own.  I received a text at 9:25pm saying that she might be in labor, to a text at 9:42 saying "meet us at the hospital"!  I knew she would progress quickly, so I wasn't surprised at all that she was 8 cm when she arrived.  

When the nurse first listened to the heart rate, it was in the 80s and 90s, which is not optimal.  But it is fairly common during the pushing phase of labor.  And by 10:40 mom was complete and ready to push.  The urge to push wasn't there, baby was facing the wrong way in the pelvis, and he wasn't really moving when mom did push.  Because of the low heart rate, the on call doctor suggested a spinal and forcep delivery!  Excuse me?  How did we go from a perfectly progressing birth to an extremely high risk situation?  I could see that the over reaction of this physician caused extreme stress for my clients.  Dad became light headed, and mom appeared panicky.  

It's a tough call, and certainly no one wants to make the wrong call when it comes to getting a baby here safely.  But with so many other things to try in between 'nothing' and 'tons of interventions', doesn't it make sense to change positions, and see if that helps?  Anyways, chosen doctor arrived, and after several minutes we were able to get mom into a new position.  And even though mom didn't like it, the baby did.  He started to descend through the pelivs, and his heart rate improved.  Chosen doctor suggested we all take a deep breath and assess.  Thank goodness she arrived when she did, because anesthesia was about to give a spinal without consent...  

Annoyance aside, everything turned out beautifully.  Was it hard?  Yes.  But was it too hard?  No.  With birth, we need to have a little more faith.  (Or alot more if you are the on call dr....)  It is really hard for a mom to have faith in her ability to birth when the medical staff over reacts.  Because despite how hard it was, this little guy slipped into the world at 23:23 (11:23 pm for you non military timers) with apgars of 8 and 9.  He sure proved them wrong!



Edmund's first kiss.  :)



Showing his sisters (who both weighed under 7 pounds at birth) who's boss, 
weighing in at almost 8 lbs and one ounce.  



This couple was a great team.  It was a bit of a crazy night... But with 3 kids, who are all very close in age, crazy nights will pretty much be the norm for these parents!