This was my first birth as a doula. It was really special for me because I was being a doula for my sister!
B texted me just before 4 AM on Sunday telling me she was pretty sure her water had just broken. She was one day shy of 41 weeks gestation. I didn't hear the text alert on my phone until an hour later and when I called her she was contracting but not regularly. I told her to call her midwife, who advised her to rest, eat, and drink and be at the hospital by 10 AM. At about 9:00 I got another text, from B's husband J, telling me B wanted me to come over. I quickly got my kids packed for their stay at my sister's house and headed to B's house. When I got there around 9:40 B's contractions were piggybacking, then coming 4–6 minutes apart. So she'd have one contraction followed immediately by another milder contraction, then she'd have a 4–6 minute break before having two contractions again. She was tolerating them well and could talk through them, but the midwife wanted B at the hospital by 10 since her water had broken, so off we went.
By about 10:40 B was almost 5 cm. She labored on a birth ball while our mom, J, and I applied counter pressure on her back. She was feeling quite a bit of back pain on one side of her lower back. At 12:55 B was checked again. She was dilated to a 5 and the baby had moved to a -1 station. B was doing well but contractions were getting intense. We got B into the tub and she labored really well in there for about an hour and a half. At 2:30 she had to get into bed for some EFM and a dilation check revealed she was nearly 6 cm. I think this discouraged B, and 20 minutes later she was saying she wanted an epidural. Knowing that the tougher contractions meant progress, I encouraged her to get through another contraction. After that contraction she was still asking for pain relief so I talked to her about the option of Fentanyl instead of an epidural, just to see if it helped. She decided to do that and was given a half dose of Fentanyl at 2:50. 5 minutes later she requested the epidural again. I suggested she try the other half of the Fentanyl dose first, which she agreed to do. After that, B started tolerating the contractions a lot better and didn't ask for an epidural again.
Around 5:00 B was checked and she was almost 9 cm! The midwife stretched B's cervix a bit during a few contractions to help complete dilation. At 5:10, B was complete and ready to start pushing! At 5:20, the midwife announced that she could see dark hair. We were all encouraging B as she pushed, and she was doing really well, but the baby was turned at an angle (explaining B's back pain). A few attempts were made to turn the baby manually but it didn't work.
B kept pushing, trying a hands and knees position as well as lunging on the birth stool while pushing. About 6:30 she was too exhausted to do any more and requested an epidural. We gladly gave it to her and by 7:15 she was covered in warm blankets, relaxing after all her hard work. Her contractions slowed, so Pitocin was started to keep them strong and help labor the baby down. B was very cold and kept shivering, so I held her hand and rubbed her legs and back to help warm her. Soon she was comfortable and able to sleep for a while. The midwife put B's legs in a position that would encourage the baby to turn and let her rest for a while. About an hour later, she came in to check progress. Baby had moved down a little bit. B started pushing again, but no progress was being made. The talk turned to forceps delivery, or possibly a c-section. After discussing all the risks and benefits, and talking about it for a while, at 9:00 B made the decision to have a Cesarean.
Baby Jack was born at 9:40. He was having some trouble with his respiration and had a fever, so after a quick moment with mommy, he was taken to the nursery, accompanied by his dad, to be taken care of. There was a long wait in recovery while Jack was suctioned, monitored, and had blood work done. Finally, around 1:30, a nurse brought Jack into the recovery room where two tired Grandmas held him for a minute then headed home to sleep. I helped B through her first breastfeeding, and once we got tired little Jack to start sucking, he was off! He ate for about 15 minutes before he was just too tired to do anymore. I left B feeling exhausted but happy, and the last view I had as I left the room was of Mommy, Daddy, and baby. A beautiful new family! I am so proud of B for all the hard work she did to bring her little baby to her!
Wednesday, November 18, 2009
Tuesday, November 17, 2009
Epidural Epidemic
By Jeanne Ohm, D.C., F.I.C.P.A.
Originally Printed in I.C.P.A. Newsletter March/April 1999
Epidurals during birthing have become so routine, as mothers are being convinced that pain during labor is unnatural. Convinced that they should not endure pain during the birth process, mothers are set up to believe in a drug instead of their bodies' own natural capabilities. Sixty four percent of certified nurse midwives reported concern over the increased number of their clients who desire epidural anesthesia, and a majority of certified nurse-midwives surveyed (53%) reported a negative attitude toward the increased use of epidurals. 1
We started including questions about births years ago on our children's case history and 9 times out of 10, mothers will check off that they had a "natural childbirth" and in the next question, they check off that they had an epidural. In other words, if they delivered vaginally, and their eyes were open, they are being led to believe that they delivered naturally.
What is not being provided to the parents is the increased complications which are a result of epidural usage. The PDR2 cautions that "local anesthesia rapidly crosses the placenta...and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity." It continues, "this toxicity can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs, headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting and seizures." Many of these side effects result in multiple complications. For example, maternal hypotension causes bradycardia (decreased heart rate) in the fetus. This altered heart rate can lead to fetal distress and operative deliveries.3 This has led doctors to warn "a high concentration anesthetics and epinephrine should be avoided, as they may influence labor."
Things To Know About Epidurals:
1. Causes longer labors with slower progress. 5, 6
2. Can cause fevers in mothers during childbirth. 7
3. Increase use of pitocin by as much as 3 ½ times, which causes slow and irregular contractions. 5 8
4. Increases use of antibiotics in your baby by as much as 4 times. 4
5. Increases use of forceps by as much 4½ - 20 times.5
6. Causes neonatal jaundice due to altered red blood cells. 9
7. Increases the incidence of birth trauma due to the use of mechanically assisted deliveries. 10 11
8. Causes adverse behavioral effects of the neonate. 12
In order to bring about a reversal in epidural usage, mothers must become educated not only on its potential side effects, but on their bodies' own ability to give birth naturally. The overwhelming fear associated with birth has become a learned behavior in our culture. Fear causes additional muscular tension in the body, resulting in decreased blood supply to organs and therefore impaired uterine function.
Originally Printed in I.C.P.A. Newsletter March/April 1999
Epidurals during birthing have become so routine, as mothers are being convinced that pain during labor is unnatural. Convinced that they should not endure pain during the birth process, mothers are set up to believe in a drug instead of their bodies' own natural capabilities. Sixty four percent of certified nurse midwives reported concern over the increased number of their clients who desire epidural anesthesia, and a majority of certified nurse-midwives surveyed (53%) reported a negative attitude toward the increased use of epidurals. 1
We started including questions about births years ago on our children's case history and 9 times out of 10, mothers will check off that they had a "natural childbirth" and in the next question, they check off that they had an epidural. In other words, if they delivered vaginally, and their eyes were open, they are being led to believe that they delivered naturally.
What is not being provided to the parents is the increased complications which are a result of epidural usage. The PDR2 cautions that "local anesthesia rapidly crosses the placenta...and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity." It continues, "this toxicity can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs, headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting and seizures." Many of these side effects result in multiple complications. For example, maternal hypotension causes bradycardia (decreased heart rate) in the fetus. This altered heart rate can lead to fetal distress and operative deliveries.3 This has led doctors to warn "a high concentration anesthetics and epinephrine should be avoided, as they may influence labor."
Things To Know About Epidurals:
1. Causes longer labors with slower progress. 5, 6
2. Can cause fevers in mothers during childbirth. 7
3. Increase use of pitocin by as much as 3 ½ times, which causes slow and irregular contractions. 5 8
4. Increases use of antibiotics in your baby by as much as 4 times. 4
5. Increases use of forceps by as much 4½ - 20 times.5
6. Causes neonatal jaundice due to altered red blood cells. 9
7. Increases the incidence of birth trauma due to the use of mechanically assisted deliveries. 10 11
8. Causes adverse behavioral effects of the neonate. 12
In order to bring about a reversal in epidural usage, mothers must become educated not only on its potential side effects, but on their bodies' own ability to give birth naturally. The overwhelming fear associated with birth has become a learned behavior in our culture. Fear causes additional muscular tension in the body, resulting in decreased blood supply to organs and therefore impaired uterine function.
Tuesday, November 10, 2009
A joke . . .
. . . with some truth to it! :)
An anesthesiologist, an OB, and a midwife walked into a bar. The anesthesiologist ordered a pitcher of stout and a double burger; the OB ordered a Reuben and a bottle of red wine; the midwife ordered their biggest plate of steak and fries with a margarita. They all sat in a booth and shared war stories.
A long time passed, and the three realized something had gone wrong with their order. They decided to find out what the problem was. They found the busboy just behind the swinging double doors to the kitchen. He was struggling to get their overloaded cart from the tiled kitchen to the carpeted dining area. The wheels kept catching on the bump.
The anesthesiologist knelt down and examined the tires. "You just need to inject something here in the back," he announced. "Then everything will go better."
The OB leaned down to look at the carpet. "This part of the carpet is blocking the cart," he announced. "Give me a knife and I'll just give it a little cut to help it along."
The midwife leaned over to the busboy and whispered loudly in his ear, "You can do this! Just PUSH!"
An anesthesiologist, an OB, and a midwife walked into a bar. The anesthesiologist ordered a pitcher of stout and a double burger; the OB ordered a Reuben and a bottle of red wine; the midwife ordered their biggest plate of steak and fries with a margarita. They all sat in a booth and shared war stories.
A long time passed, and the three realized something had gone wrong with their order. They decided to find out what the problem was. They found the busboy just behind the swinging double doors to the kitchen. He was struggling to get their overloaded cart from the tiled kitchen to the carpeted dining area. The wheels kept catching on the bump.
The anesthesiologist knelt down and examined the tires. "You just need to inject something here in the back," he announced. "Then everything will go better."
The OB leaned down to look at the carpet. "This part of the carpet is blocking the cart," he announced. "Give me a knife and I'll just give it a little cut to help it along."
The midwife leaned over to the busboy and whispered loudly in his ear, "You can do this! Just PUSH!"
Sunday, November 8, 2009
Friday, November 6, 2009
Tuesday, November 3, 2009
Q&A
With Dr. Michel Odent. Very interesting. Plus, I'm always happy to find doctors that are well educated, PLUS are interested in the best for the mother. In here he even says "In an ideal world, we should not contrast home birth and hospital birth. When an effective communication has been established between the home birth midwife and the obstetrical team, it should be possible to combine what the privacy of the home can offer and what the hospital facilities can offer."
http://www.waysofthewisewoman.com/dr-michel-odent-notes-obgyn-studies.html
http://www.waysofthewisewoman.com/dr-michel-odent-notes-obgyn-studies.html
Monday, November 2, 2009
Doula at a C-Section?
Many women who are facing a Cesarean Section—scheduled or otherwise—may wonder whether a doula can be helpful at their birth. The answer is yes!
Doulas attend all kinds of births: unmedicated, medicated, VBAC, and Cesarean, at home, at a birth center, or in a hospital. Part of a doula's role is to create a bond with the mother so as to provide reassurance and comfort. As you meet with your doula in the weeks leading up to your birth, you will develop a friendship that will make your doula an ideal person to have at your side during a stressful situation. A C-section is major surgery that is likely to cause anxiety or distress, especially when an emergency C-section is ordered, but also when a C-section is scheduled ahead of time.
A doula can inform you of some of the aspects of the surgery, stay by your side to calm and comfort you during surgery, and be with you afterward to help with breastfeeding. In the case of an emergency Cesarean, if the baby needs to be quickly treated for medical problems, your doula can stay with you, allowing your husband or birth partner to go with the baby. If the baby needs to stay in the NICU, the doula can act as a link between the mother in recovery and the baby in the NICU, bringing positive news to the mother.
Another very important role a doula can play in a Cesarean birth is talking about the birth with you, helping to fill in gaps and holes in the birth story, helping you process the experience and resolve negative emotions. This can be especially important when a woman has planned to have a vaginal birth and ended up with an emergency C-section. Seeing all your plans fall apart in the case of an emergency can make you feel out of control and can bring up feelings of failure that you were not able to proceed with the birth as you planned. A doula can help you understand the necessity of what happened, talk through parts of the birth that frustrated, angered, or frightened you, and leave you with an overall feeling of positivity toward your birth.
A postpartum doula can also be especially helpful in the case of a Cesarean birth. The recovery from a C-section is long and difficult. A postpartum doula can help with laundry, cooking, cleaning, and baby care, allowing you to get the rest necessary to recover and to focus on bonding with your baby and establishing breastfeeding. A postpartum doula can also help manage visitors, ensuring you get the rest and alone time you need to recover as quickly as possible.
If you're having a planned C-section, or find yourself in the position of needing an emergency C-section, remember that a doula can still be a friend, comfort, help, and advocate for you, helping to make your birth a positive experience and a happy memory to carry with you for the rest of your life.
Doulas attend all kinds of births: unmedicated, medicated, VBAC, and Cesarean, at home, at a birth center, or in a hospital. Part of a doula's role is to create a bond with the mother so as to provide reassurance and comfort. As you meet with your doula in the weeks leading up to your birth, you will develop a friendship that will make your doula an ideal person to have at your side during a stressful situation. A C-section is major surgery that is likely to cause anxiety or distress, especially when an emergency C-section is ordered, but also when a C-section is scheduled ahead of time.
A doula can inform you of some of the aspects of the surgery, stay by your side to calm and comfort you during surgery, and be with you afterward to help with breastfeeding. In the case of an emergency Cesarean, if the baby needs to be quickly treated for medical problems, your doula can stay with you, allowing your husband or birth partner to go with the baby. If the baby needs to stay in the NICU, the doula can act as a link between the mother in recovery and the baby in the NICU, bringing positive news to the mother.
Another very important role a doula can play in a Cesarean birth is talking about the birth with you, helping to fill in gaps and holes in the birth story, helping you process the experience and resolve negative emotions. This can be especially important when a woman has planned to have a vaginal birth and ended up with an emergency C-section. Seeing all your plans fall apart in the case of an emergency can make you feel out of control and can bring up feelings of failure that you were not able to proceed with the birth as you planned. A doula can help you understand the necessity of what happened, talk through parts of the birth that frustrated, angered, or frightened you, and leave you with an overall feeling of positivity toward your birth.
A postpartum doula can also be especially helpful in the case of a Cesarean birth. The recovery from a C-section is long and difficult. A postpartum doula can help with laundry, cooking, cleaning, and baby care, allowing you to get the rest necessary to recover and to focus on bonding with your baby and establishing breastfeeding. A postpartum doula can also help manage visitors, ensuring you get the rest and alone time you need to recover as quickly as possible.
If you're having a planned C-section, or find yourself in the position of needing an emergency C-section, remember that a doula can still be a friend, comfort, help, and advocate for you, helping to make your birth a positive experience and a happy memory to carry with you for the rest of your life.
Sunday, November 1, 2009
Inspiring Quotes
We are made to do this work and it's not easy...I would say that pain is part of the glory, or the tremendous mystery of life. And that if anything, it's a kind of privilege to stand so close to such an incredible miracle.
-Simone in Klasson 2001
Anything I’ve ever done that ultimately was worthwhile…initially scared me to death.
-Betty Bender
I think one of the best things we could do would be to help women/parents/families discover their own birth power, from within themselves. And to let them know it's always been there, they just needed to tap into it.
-John H. Kennell, MD
We have a secret in our culture, and it's not that birth is painful. It's that women are strong.
-Laura Stavoe Harm
The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.
-Heather McCue
Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth.
-Virginia Di Orio
Mothers need to know that their care and their choices won't be compromised by birth politics.
-Jennifer Rosenberg
The wisdom and compassion a woman can intuitively experience in childbirth can make her a source of healing and understanding for other women.
-Stephen Gaskin
There is power that comes to women when they give birth. They don't ask for it, it simply invades them. Accumulates like clouds on the horizon and passes through, carrying the child with it.
-Sheryl Feldman
There is no way out of the experience except through it, because it is not really your experience at all but the baby's. Your body is the child's instrument of birth.
-Penelope Leach
I discovered I always have choices and sometimes it's only a choice of attitude.
-Judith M. Knowlton
If I don't know my options, I don't have any.
-Diana Korte
-Simone in Klasson 2001
Anything I’ve ever done that ultimately was worthwhile…initially scared me to death.
-Betty Bender
I think one of the best things we could do would be to help women/parents/families discover their own birth power, from within themselves. And to let them know it's always been there, they just needed to tap into it.
-John H. Kennell, MD
We have a secret in our culture, and it's not that birth is painful. It's that women are strong.
-Laura Stavoe Harm
The whole point of woman-centered birth is the knowledge that a woman is the birth power source. She may need, and deserve, help, but in essence, she always had, currently has, and will have the power.
-Heather McCue
Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth.
-Virginia Di Orio
Mothers need to know that their care and their choices won't be compromised by birth politics.
-Jennifer Rosenberg
The wisdom and compassion a woman can intuitively experience in childbirth can make her a source of healing and understanding for other women.
-Stephen Gaskin
There is power that comes to women when they give birth. They don't ask for it, it simply invades them. Accumulates like clouds on the horizon and passes through, carrying the child with it.
-Sheryl Feldman
There is no way out of the experience except through it, because it is not really your experience at all but the baby's. Your body is the child's instrument of birth.
-Penelope Leach
I discovered I always have choices and sometimes it's only a choice of attitude.
-Judith M. Knowlton
If I don't know my options, I don't have any.
-Diana Korte
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