Pampered Pregnancy – Blissful Birth

The Birth of Story                                                                                        Aug. 7, 2010

Early Saturday morning around 7:30am, your mommy called me, explaining how she was having some pretty intense contractions about 5 min. apart and maybe 30-40sec. long.  She had had some the night before, but since they were very manageable, she decided to go to sleep, and get some rest for your big day.  As her doula, (a fancy word for a person who helps moms and dads through the birth process), I was excited to meet you too, and I began to get ready to meet your mom and dad at their house to help them get ready to meet you.

I got another phone call from your daddy about an hour later, saying that yes, indeed, your mommy lost her mucous plug and the contractions were still intense.  I asked him if he would like to just meet at the hospital now, or if he still wanted me to come to their house.  He said to just come on over.  I arrived at your house around 9:15am, and your mommy was sitting in the restroom having some very strong contractions.  They were a little closer together, and seemed to last a little longer than before.  Your mom also started to express some doubts about giving birth, saying, “I don’t know if I can do this.”
Now, don’t worry, Story.  This is very normal for women to say during labor, especially towards the end, during a time called transition.  Judging from the intensity of her contractions, her emotional state, and the long drive we had to get to the hospital, I told your mommy and daddy I thought we had better take off.  Your daddy was ready to go in a heartbeat, and after holding your mommy for a few good contractions, we finally got her and your grandma into the car.

Following your daddy to the hospital was quite an adventure!  Sometimes he was even going 95 miles and hour. (This is very fast, just in case you want to know.)  We arrived from SW Austin to St. David’s in Georgetown in record time, and got your mommy checked into her labor and delivery room around 10:45am.  She sat on the toilet for a while, and tried to get in the bed for the nurses to get a good read on your heartbeat, but it was very hard to do this.  You see, her contractions were at this point very strong and close together.  I held her while she stood up and we rocked back and forth, and I kept telling her she could do it when she said she couldn’t.  She did great when it came to taking good deep breaths and relaxing her body, so that you could eventually make your way out.  When we finally got her onto the bed, she was 8 cm dilated, and definitely in transition.  She was also very patient with all the nurses’ questions and proddings during this time, which was very impressive.  When the Dr. came in and checked you mommy, she was very impressed that your mommy was already dilated some more to a 9.5.  Your mom was ready to push, and the doctor held back a small cervical lip while she squatted and pushed with a birthing bar for a while.  Then, she laid back and with all her strength, and a few more good pushes you were born!

You had such a sweet little cry and went from purple to pink very quickly.  Already, you had beautiful curly, dark hair and pink chubby cheeks!  You weighed a little over 7lbs.  Your daddy and grandma and I were there to cheer you and your mommy on.  You were also born one day before your daddy’s birthday and one day before your due date, Aug. 7, at 12:58pm.  This was only a little over 2 hours after being at the hospital!  Wow!  Not only did you come fast, but your mommy was able to deliver you naturally, with no medications at the hospital!  What a Momma!  What a Baby!

The birth of Emmett Hiller  by Amy Nevland

Meghen called me a little after noon from her place of work, describing how she thought her water had broken while she had used the restroom.  After listening to the details, I agreed with her, telling her that’s what I thought, too.  Because she wasn’t having any contractions yet, she wrapped up her stuff at work and got her bags together.  However,  since her baby was at 34 weeks and 4 days gestation, she did need to head to the hospital as soon as she could.  When she arrived at St. David’s around 2:15, her contractions had begun and were quite frequent.  She was 2cm and 75% effaced at the time.  She was immediately put on antibiotics and some IV solution to protect from unknown infections and to slow down the contractions.  This worked for a few hours; however, when I arrived at 5:15pm her contractions had picked back up again.  She did not have her dilation checked again until 11pm when she began having an urge to push.  At this point she was 10cm dilated and 100% effaced!  She breathed-pushed while reclining, and while squatting.  While squatting at the bar, though, the baby’s heartbeat decelerated, so she had to lie back down.  About an hour and a half later, a very healthy 6lb 15oz Emmett was born.  She received an episiotomy that was stitched-up, and had no 3^rd stage complications.  Emmett was an 8 on the apgar, but was still taken almost immediately to the NICU due to his gestational age and some minor breathing issues.

As Meghen’s doula, I first gave her a crash course on nursing when I arrived at the hospital (b/c she hadn’t gotten to go to the class yet). Then we walked the halls together, even with her siblings in tow. (I showed her younger brother how to apply counterpressure on her back during one of the contractions.)  I applied counterpressure on her back quite a lot actually, as she was heaving quite a bit of back labor.  I also tried to make sure that she and Everett got all their questions answered by the doctors and nurses in a clear way.  This was very important, as Emmett was going to be spending some time in the NICU and this changed up the birth plans a bit. Later on, I got her husband some dinner at one point, and aided in reminding him where and when to provide massages and counterpressure.  During her transition time, I was more aggressive in reminding her to use her breathing techniques and to use a low voice.  When she was asking for the epidural, she was also saying she really needed to poop, but couldn’t.  The nurse and I discussed with her seeing where she was in her progress first.  That was when we found out it was indeed time to push.  During the pushing phase, I helped make sure she was able to try to push with the bar in squatting position for a while, and encouraged her on how well she was breathing.  I also was with her during the early postpartum phase while daddy was with the baby.

Meghen’s reaction to labor and birth was fearless.  She was able to go with the flow pretty well considering Emmett was a bit early, and things were not going according to the original plan.  The only times she seemed a little distressed was after the nurse from the NICU came and gave her the best case/ worst case scenarios.  She did regain her courage and go-with-the-flow positive attitude very quickly, though, and we were able to get out of bed and work on her contractions again.  She also had a very classic response to transition, complete with shaking and nausea, and saying “I can’t do this.”  But, besides those two very short times, her hypnobirthing techniques really did seem to carry her through labor and birth contractions very beautifully and calmly.  (She was picturing blowing up balloons.)

It was very fun to observe Meghen do her hypnobirthing thing and figure out how I could support her in this, as I had never done this before.  Her birth also reinforced how sitting on the toilette in the dark can be a very positive position to labor, in as this seemed to help her progress well and calmly. I also learned that not all 34/35 week olds are going to be “small.” Emmett was 6lbs, 15oz.

Dana’s baby was due July 19. By July 29, after experiencing regular contractions for over 10 days, Dana was getting pretty tired of being pregnant. Her doctor scheduled an induction for Friday, July 30. The day before the induction, Dana’s doctor inserted a catheter into her cervix to try to get the cervix to start opening. That way, by Friday, her body would be better prepared for induction. I planned to meet Dana and her husband Wade at the hospital at 7:00 am on Friday morning.

The catheter was not supposed to be any less comfortable than a tampon – but for Dana it was excruciating. In most people, the procedure doesn’t cause contractions, but Dana started contracting as soon as the catheter went in. The contractions were excruciating and came right on top of each other, with no break in between to recover. Dana had to wait with her midwife after hours for her husband to come pick her up, because she was in too much pain to drive.

When I spoke to Dana at 7:30 pm, her contractions were 3 minutes apart. She had labored in the tub for a while, and wanted to try to sleep at home if she could. But about an hour later, she started noticing some bloody show and decided to go to the hospital. She got there at 9:30 pm and I met her there an hour later.

Dana, Wade, and baby Ella, born 7/30/10

Dr. Schmitz and Dana’s nurse Ashley were surprised to learn that Dana was 6 cm dilated. Dana’s contractions slowed down after she arrived at the hospital, so we tried walking the halls to speed things back up. The contractions did come faster when Dana would walk, but we could only walk for 30 minutes at a time – we had to go back to the room so Dana could get back on the monitor for 5 minutes. The contractions would slow down again as soon as Dana stopped walking.

I suggested she try sitting on the birth ball to be monitored, in an attempt to use gravity and the movement of Dana’s hips and pelvis to allow the baby to descend. But the contractions still only sped up when Dana would walk, and she was tired. By 1:00 am, Dana concluded that her contractions were continuing the pattern of the past 10 days; they were not increasing in intensity or becoming more frequent. She wanted to preserve her energy for the induction in the morning, so she decided to try to sleep. I tucked her in with her fluffy pink body pillow and set up the convertible couch/bed thing for Wade, and then I went home for the night.

Dana promised to call me if anything happened overnight, but nothing did. She hadn’t slept much for the past 3 days so she was really tired, but she still couldn’t sleep. After a Phenergan at 4:30 am, she was able to doze for a couple of hours.

When I got back to the hospital at 8:00 am, Dana was munching on banana bread and looking beautiful and completely refreshed – although she said she was still really tired. I tried some labor-inducing acupressure, which brought on contractions but did nothing to speed them up or really get labor going  At 9:15, the midwife Lisa came to talk to Dana and Wade about how they wanted to proceed with the induction.

The options were pitocin or breaking the bag of waters, also called AROM (artificial rupture of membranes). Dana wanted to avoid the discomfort of the baby’s head against her cervix that AROM would cause. She chose pitocin because Lisa explained that they’d start it very gradually to find the smallest dose that would work. Lisa said that pitocin wouldn’t make the contractions any more painful than natural labor. Dana’s nurse Heidi started the pitocin at 9:30 am.

As soon as the pitocin started, Dana began feeling anxious. She worried that pitocin would make her contractions extremely painful, and after the ordeal yesterday, she was all too aware of how painful they could be. I encouraged her not to worry about what might happen and just deal with what was currently going on. By starting pitocin at 6 cm Dana was already ahead of many women who get induced, and she was coping very well with the contractions she was having now. So far, everything seemed to be going smoothly.

Dana and Steph

At 10:15 Dana felt a bit lightheaded. About 5 minutes later, Heidi came in and said that the baby’s heart rate was a bit low, so she had Dana lie down for a while. The baby’s heart rate immediately returned to the normal range, and Dana enjoyed the rest, so she stayed in the side-lying position for a while.

Dana and Wade were really funny, constantly griping at each other playfully. They really cracked me up and I loved seeing how Wade used humor to lighten the mood and get Dana smiling and not worrying so much. Around noon, Wade told Dana, “You know, if we want to have another one you’re going to have to execute a little better next time.” Dana just kind of rolled her eyes. Later she told him, “You try pushing a baby out of your penis hole!!” He didn’t have much to say to that.

My favorite quote of the day, though, came when Wade had to get rid of some of the photos on their camera to open up more memory for baby pictures:

Wade: Do you want this picture of this dog humping this lady’s leg?

Dana: Well, it was really funny.

Wade: Do we need all four?

We placed bets on how much the baby would weigh. Wade guessed 8 pounds, 6 ounces. Dana guessed 8 pounds, and then Wade wanted to change his answer to make it lower, but Dana and I called him out on that, so he had to stick with his original guess. I guessed 7 ½ pounds.

Until around noon, we had been joking around and chatting about things like 15 pound babies, snake handlers, Appalachian weirdos, and people who live in the New York subway tunnels. Just the usual sort of chitchat. But around noon, active labor set in, and things started to get more serious.

Meeting Ella

Looking over my notes now, I’m amazed to see how quickly this happened. We moved around the room trying different positions that would allow me to massage Dana’s back between contractions and do the double-hip squeeze during contractions. Dana tried standing and leaning over onto the birth ball, sitting on the birth ball, and sitting on the toilet facing backward so I still had access to her back. Ame, my Get Babied doula buddy, popped in to say hello during this time – she had been down the hall working with another client having an induction. Dana and Wade both said hi to Ame and talked to her a bit.

By 12:30, Dana was sitting on the ball moaning through her contractions. I encouraged her to keep her voice low and deep and her throat open, so she could relax and her cervix could open. This came naturally to her at first, but it became more difficult with each contraction. Over the next half hour, she went from moaning deeply with control to sobbing hysterically and nearly hyperventilating. I could guide her to get control of her breathing between contractions, but during contractions she was in so much pain that she was overwhelmed.

At 1:00, Dana announced that she was done. I reminded her that this was what happens in transition, when you’re almost ready to push – it’s the hardest part of labor but also the fastest. I knew Dana was ready to give up. I asked her if she’d like to get checked to see how dilated she was – because learning that you’re at the end of transition can be a great motivator to keep going.

Dana got checked; she was 7 centimeters and 80% effaced. She was discouraged and knew she was too overwhelmed and exhausted to continue to deal with the ever-increasing contractions. I asked if she could just take it one contraction at a time and see if she could get through three more, but she said no. I suggested she get on her hands and knees because that might help ease the pain in her back – no again. I asked, “What do you want to do?” Dana looked straight into my eyes and said clearly, “I want an epidural.” I smiled and said okay.

Heidi explained how the epidural would work, and told us that she had called the anesthesiologist but Dana still needed to get a bag of fluid through her IV first. So we still had quite a bit of coping to do. Dana was up for it – knowing that relief was on the way was really encouraging to her. Lisa came in to talk to Dana about the epidural too. Lisa assured Dana that accepting pain medication is not a failure; everyone’s labor is different and you never know how it’s going to be till you’re in the situation.

The next hour was very intense as we waited for the anesthesiologist, Dr. Miller, to arrive. He placed the epidural at 2:00 pm and by 2:15 Dana’s contractions were manageable. Finally she was able to get some much-needed rest. She felt disappointed that she got the epidural – she knew she couldn’t have kept going, but she wished that she could have.

At 3:20 pm, Dana’s cervical check showed that she was 8 cm dilated, 100% effaced, and the baby was at -1 station. Dana requested AROM to help speed things along, and when Lisa broke the bag of water we learned that there was thick meconium. Lisa explained that because of the meconium, they wouldn’t stimulate the baby immediately after birth; instead, they’d try to suction the meconium before the baby cried and possibly inhaled it.

"Thanks, Dad, for wearing your lucky shirt today!"

Another cervical check about an hour later revealed that Dana was almost completely dilated, and she was 100% effaced. At 4:30 Heidi explained that they wanted Dana to try to labor down as much as possible to get the baby lower without having to push as long.

At 5:05, Dana was complete and the baby was at +2 station.

We could see hair as soon as Dana started pushing. Heidi and Lisa explained how to push, and Dana did beautifully. She made it look so easy! I held one of her legs and Heidi held the other, and Ella was born in under 30 minutes.

Ella wasn’t too happy about all the suctioning, but she didn’t have to put up with it for very long. The nurses worked quickly, and in a few minutes Ella was ready to get weighed and measured. She was 21” long and weighed 7.2 pounds – so my guess was the closest! She was absolutely gorgeous, with beautiful long graceful fingers and long, thick eyelashes. I took some pictures and video of her first moments as her parents finally got to meet her.

I know Dana would like to have had a natural birth. I tried to help her understand that she was amazing for having worked so hard and gone through all that she did. She had never experienced anything as intense and painful as what she did that day – I hope she gives herself credit for that. And I hope she realizes that it takes a lot of strength to recognize that things aren’t going how you’ve planned and you’re going to have to do things differently from how you’d hoped. There’s definitely power in being able to accept that.

Doesn't that smile just melt your heart?

40 weeks came and went for Valerie. Then 41. 1 day shy of 42 weeks was her scheduled induction date. I joined Valerie and Brendan a few hours after they checked in to find Valerie comfortable on a low-dose of pitocin. Valerie is the perfect doula student – she had read every hippy trippy birth book out there (which we love). She watched all of the required documentaries (The Business of Being Born, Orgasmic birth). She took all of the classes we offer at Get Babied and was as educated about her choices in birth as any mom could be. So Valerie knew the pros and cons of medical inductions, epidural anesthesia etc. She hoped that a little pitocin would get her to a place where her baby would be low enough for an artificial rupture, and the AROM would stimulate her own oxytocin where she could turn the pitocin off. This was the plan, and the plan worked beautifully. By mid afternoon Valerie was off of the pitocin, off of the IV, and off of the continuous monitoring, free to walk the halls and labor as she pleased. She was about 6cm and contracting regularly. Things looked beautiful for Valerie and the spiritual birth experience she was hoping for.

Val liked three positions for laboring – sitting on the toilet, walking the halls and taking contractions leaning against the wall, and doing a hands and knees position on the hospital bed using a ball at her head and Brendan and I at her hips for counter pressure. She would labor in a position for a good 15 minutes, and then as soon as she needed a distraction, she would choose a new position. Her positions were all different and used gravity to her advantage to get her cervix open and her baby down. Her hospital room was also set up so peacefully. She chose to have the lights turned low. She had yoga-meditation music on her ipod dock. Lavender aromatherapy lingered in the air.

Valerie entered transitional labor in a calm, peaceful, inwardly reflected, deep breathing state. When a contraction (we called them rushes in honor of Ina May Gaskin’s Spiritual Midwifery, which was preferred reading material in early labor) started she would breath deeply, close her eyes, and choose a mantra with the words open or relax or similar in her head. When the rush reached it peak she would use her voice in a very low grounded bovine (again thanks for the reference Ina) moan. She moved progressively to a cervical exam that put her at 9.5 centimeters. 9.5 is my pet peeve of the week it seems (Val is the third mama of ours this week with an issue of incomplete dilation). As a doula I knew that anterior lips and cervical swelling without pushing are often an indication of occipital posterior (OP) position of the baby – “sunny side up”. Immediately we employed positioning that would take any pressure off of the cervix (like squats and such) and moved to positions that created the most room for baby to rotate – hands and knees, lunges, and side lying. Valerie took each position in stride.

Brendan was a wonderful birth partner. He would hug and kiss Valerie to help maintain intimacy throughout her labor. When Valerie was having a difficult rush he would give her relief by doing a double hip squeeze, and when it was my turn to take over double hip squeezing he would be at her head scratching her scalp and playing with her hair, something she found soothing and relaxing. When the peaks of the rushes were intense, he would moan along with Valerie and remind her to take deep breaths, and to keep her voice low and body relaxed.

For most people transition labor (8-10 cm) can be between 30-90 minutes. Intense, but brief in relation to the journey of labor. For Valerie it was over 4 hours. Not once did she feel she couldn’t manage her pain. Not once did she ask for pain relief. She didn’t look at the clock. She just stayed in her zone and hoped that time would be on her side to get her baby turned rotated and engaged in her pelvis. After 4 hours Lisa Carlisle the midwife (of OBGYN North) actually recommended the epidural. Valerie continued on past this recommendation for an hour or so, but ultimately decided that it was time to change plans. The midwife was hoping the epidural would give Valerie a rest – she had been working hard for 15 hours and a rest might help her body relax. She also recommended turning the pitocin back on – while resting this would turn her contractions up a notch, and might also help in finishing that dilation. With a quick cat nap under her belt and within the hour, Valerie was feeling the uncontrollable urge to push. Her epidural was perfect – took the pain of the peak of her contractions away, kept the pushing pressure sustained, and she had full feeling and mobility of her legs.

Valerie pushed for about 45 minutes in alternating positions. She pushed on hands and knees and side lying – two positions that were comfortable for her, but also kept maximum pelvic room to keep the baby rotating. 45 minutes of pushing brought no progress. The midwife recommended another hour break, where Valerie could rest and the pitocin/epidural combo could keep working for her to labor baby down without Valerie getting exhausted. After another hour, Valerie needed to push again. This time we tried even more positioning; hands and knees, side lying, lying on back and pulling against a rebozo, and pulling out the squat bar to squat “Indian style” while pushing. 45 minute more of strong effective pushing still did not bring baby in to the pelvis. Val’s cervix was swollen even more, and the top of baby’s head was starting to swell.

Valerie working the squat bar

Valerie knew she was essentially out of options at this point, but I have to respect the nurses and midwives at NAMC – not once did any medical staff member even mention the word ‘C-section’. After the 23rd hour (literally) of labor the midwife told Valerie she could keep resting, and keep pushing – baby on the monitor was tolerating everything very well. If Valerie had the energy, she could continue as long as she wanted. But she was also a realist with Valerie – she said Valerie had tried everything she possibly could to get this baby out – and all of the things she had implemented one would think that this baby would be dropping out by now, and that more of the same might not make any difference.

It’s a beautiful thing when a C-section isn’t an emergency, and isn’t an ultimatum (“you can push for 2 hours and then it’s a C” – I seem to hear that attitude or tone from other doctors). Valerie had all of her options on the table, and it was her choice to elect to have a C-section. Many of us consider a C-section the end of the world. But to Valerie it was an empowered decision she chose. Valerie went in for the surgery around 5:30 in the morning, and baby Lilah Mae was born at 5:57, about 24 hours after Val had checked in. The C-section did confirm our suspicions – Lilah was OP and was not engaged in the pelvis. She was 8 lb 9 oz, pink, chubby cheeks, calm, peaceful (just like Valerie’s labor had been).

I met Valerie in recovery to talk about her experience. She felt that from beginning to end she had a spiritual and empowering experience. She had full freedom to labor the way that she wanted to. She discovered things about herself she didn’t know – how she had it within her to labor with intense pain and manage it on her own. She rediscovered a beautiful intimate connection with her husband whose hands were on her the entire time in a loving and supportive way through the end of her c-section. She felt a connection to her baby throughout labor and delivery and had time to get skin to skin contact with her right after her c-section delivery, and for a full hour of successful breastfeeding within a few minutes of arriving in recovery. I am so grateful to have had this learning experience, and to be reminded that a C-section can be a graceful, empowered and spiritual experience.

Lilah Mae Sterne born July 31st 2010

If you look closely you might see Get Babied! doulas Janet and Margaret busting a move.

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Roslyn* called around 7pm to let me know that she thought her water had broken.  She wasn’t having any contractions yet, but did head over to the hospital to confirm her suspicions.  Her water did indeed break, but she decided to wait until her contractions picked up before she wanted me to join her and her husband at the hospital – this gave them some time to get checked in, and get settled in to their delivery room.  By 10pm her husband Neil called me with an update, indicating that contractions had indeed started, and that they could use my support.

I whisked over to the hospital and found them in their room working through a contraction.  Roslyn found it most comfortable leaning against the wall while Neil offered some counter pressure on her lower back.  (He remembered what he had learned at our prenatal comfort measure appointment!).  Roslyn was smart to ask for a hep lock and a mobile telemetry monitor, which offered her complete freedom of mobility.  To use gravity to our advantage to improve Roslyn’s dilation from 2cm, we decided to walk the halls of the L & D unit.  They have a lovely circuit set up where we could walk continuously around the nurse’s stations at either side of the maternity ward.  We learned that the entire circuit took exactly two contractions.  After many loops Roslyn decided that she was getting pretty tired, and didn’t want to wear herself out for the upcoming labor and pushing ahead, so we went back to the room to try some other gravity friendly positions.  We tried hands and knees, birth ball, and some sitting positions – contractions at this point were getting more intense, and closer together. Roslyn moved to a seated position on the bed, Neil helped her relax by massaging her shoulders, and I worked on bringing her attention to her breath by counting out 10-12 breaths for each contraction.

At 12:30 am Roslyn decided it was time to get an epidural.  Her birth plan included the epidural option, she had wanted to see how far she could make it on her own.  After making the request for the anesthesia we learned that the only anesthesia physician attending in L&D was currently in a C-section, so we’d have to wait until they were done.  Roslyn was slightly distressed, but realizing there was nothing we could do about it she kept working through each contraction by closing her eyes, and focusing on her breath, while I counted each contraction out for her as a distraction technique.  We did this for about 90 minutes, and the anesthesiologist walked in like a breath of fresh air.  Roslyn had some anxiety about getting the epidural, but the anesthesiologist was confident, precise, and fast; and before she could even build up concern, he was done and she felt relief from the contractions within minutes.  Since Roslyn’s membranes were ruptured, she wasn’t having too many cervical exams conducted, but by 2am after the epidural was administered she was near 6cm and 75% effaced.  She had worked very effectively on her own before the medicine and progressed 4cm in those 4 hours.

Once Roslyn was comfortable (pain wise) I noticed that her husband breathed a huge sigh of relief too.  At this point he could barely keep his eyes open – having dealt with all the stress and anxiety to get to this place.  Roslyn and Neil had tried many years to get pregnant, with multiple fertility treatments and a previous miscarriage, this had been a long road.  He promptly curled up on the pull-out bed and crashed hard.  Roslyn commented that at home he needed dark and quiet to sleep.  Here in the hospital room it was neither, but that didn’t seem to bother him.  Roslyn felt very happy with this – it was an indication to her that Neil felt relieved and felt confident that Roslyn was in a good place, and had good support.  Now that Roslyn had her epidural she was more relaxed, and we spent the wee hours of the morning discussing the next phases of labor, items in her birth plan she wanted me to advocate for, breastfeeding and babycare, and of course other non-birth related gossip.  Roslyn often stays up late, and she was too excited to sleep anyhow.  Our night nurse Lisa was lovely.  It turns out that she only had one other patient, who was probably sleeping, so she spent a lot of time in our room chatting it up about her various husbands, how she lost 100 pounds on the swine flu diet, and gave us the code to the “good” snack room.

The time flew by and at the 7am shift change the new L&D nurse came on duty and did a cervical check to get an update on Roslyn’s progress.  She was now about 8cm and 100%.  Things were looking very promising.  Another check on the doctor’s round at 11am and she was 9cm.  She had a cervical “lip” and some swelling.  She would be 10cm except for this nasty lip that wasn’t going away.  At 12pm, still at 9cm with lip, the doctor was showing some concern.  A normal labor progress curve is a slower dilation from 0-5 cm, and after that you see dilation move at a much faster rate.  Being that Roslyn’s labor was doing the opposite, he was concerned about her uterine dystocia.  Before moving on to more serious interventions, he inserted an intrauterine pressure catheter to determine if Roslyn’s contractions were strong enough on their own to be able to complete her dilation.  After he left, Roslyn started to shed some tears.  She was coming to terms with the fact that a c-section was a likely outcome.  I told her to stay strong, that time was on our side, and things could still turn around.

After an hour on the IUPC, it turned out that contractions were fairly strong, but could be stronger.  So doctor’s diagnosis was that it was either 1.  Big baby  2.  Small pelvis 3. Malpresentation. 4.  Weak contractions.  He said there wasn’t anything he could do about 1, 2 or 3, so the options were to either add a low dose of pitocin to see what might happen, or to move to the OR and proceed with a C-section.  Roslyn had some concerns about pitocin – her baby’s heart right was slightly high, and Roslyn had a slight fever.  She felt if the pitocin regime caused hyper stimulation of her uterus it would cause more distress to her baby and move her from scheduled c-section to emergency c-section.  She was also concerned about continuing to labor since the “24 hour time limit” since water broke was approaching and if she had to get a c-section anyhow at that point then might as well just do it now.  The on-call doctor for her practice, Dr. Phillips of Austin Area OBGYN (we’ll call him “Ken” for the sake of the story) is my new favorite from that practice based on his answers to Roslyn’s concerns.  He said that there was nobody more concerned about the health of their baby then he was, and he wouldn’t recommend pitocin if he thought it would be detrimental.  He was not concerned about that elevated heart rate – since it was consistently elevated from early labor, he thought baby just had a higher baseline, and since he didn’t see a pattern of any late decelerations or other indications of baby not tolerating labor he was not concerned.   He also said more than once, “the last thing we want to do is rush to a c-section”.  Finally he said “There is no clinical significance to the 24-hour deadline for delivery after water is broken.  As long as you and baby are healthy, you can continue to labor as long as you need to.  We just need a plan for this uterine dystocia.”  I loved this – he is totally correct about that time frame (recent studies have come out indicating that there are no differences in rates of infection between those delivered within 24 hours, and those that just wait it out).  Also, he built up confidence in Roslyn by giving her options while at the same time did not force her a direction she didn’t want to go.  Finally – he said she could try low-dose pitocin – and if there were any negative effect, they would shut it off immediately.

Seeing that “Ken” was making the pitocin regimen as safe and as minimally invasive as possible, Roslyn decided to try that option first before going to a c-section.  The doctor wanted her to give pitocin an hour to have effect.  But number 3 on his diagnosis list was still nagging at me.  It seemed pretty clear that Roslyn’s baby wasn’t in a perfect OA position – she was having a stalled labor and her cervix was swelling prior to pushing and had an anterior lip, both indications of an OP baby.  In the natural birth world, if you have an OP baby, you change positions to help use gravity to get that baby to turn.  Hands and knees works wonders.  I asked the nurse about position options, but since Roslyn had an epidural she felt we were limited in what we could do with positioning.  In a lucky turn of events, this assigned nurse had been called to another room for a delivery, and Roslyn got a new nurse, Barbie (yes that is her real name).  The first thing Barbie asked when she walked in was “Have you guys tried hands and knees?”  We asked “Is that even an option?”.  And she said “Can you move your legs and bear weight”?  Roslyn said “I don’t know but I’m willing to try!”  As a doula – I’ve always been told that hands and knees is not an option for medicated mamas – but Barbie has rocked my world by proving that it is.  She said as long as you are on the bed, you can technically do whatever you want.  Dad, Barbie and I all helped Mom flip around and maneuver into a hands and knees position on the bed.  Her epidural was perfect – took away all of the painful sensations in the uterus, kept pressure in the pelvis, and maintained good feeling in her legs.  I hopped on the bed and started rocking her hips back and forth and in circles.  With gravity helping us, and having an open pelvis with the rocking, we were hoping baby would turn thus completing dilation and avoiding a c-section.  We had an hour to prove to “Ken” that we could do a natural delivery.  After being on hands and knees for 15 minutes or so Barbie kept us on moving by flipping Roslyn to her side for 15 minutes, to the other side for 15 minutes, and then back up to hands and knees for 15 minutes again.

I'm rocking Roslyn's hips to rotate that baby from OP to OA

Near the end of our pitocin happy hour, Roslyn was feeling the urge to push (another benefit of her light epidural).  Doctor “Ken” came in to check her, and confirmed that yes, Roslyn was at 10cm, the lip was gone, the hands and knees work and hip rocking (and pictocin) had worked to avoid a c-section.  At this point baby was low enough for Roslyn to push out and the OR staff was off notification.  Barbie, Roslyn, Neil, and I almost cried in relief that Mom would get to birth the way she had wanted.  I truly think the nurse change-over saved Roslyn from a C-section.  Dr. “Ken” bid farewell and said “see you in a few hours – you guys work on getting this baby out and call me when she’s crowning”.

Barbie again proved to be a rockin’ nurse, seeing that Roslyn had great mobility she suggested doing some gravity-friendly pushing positions as well.  Roslyn took turns pushing on her side, on her back, on the other side, and back again.  We even brought the squat bar out, and Roslyn tried a few pushes in a squat.  She felt the side and back positions were better for her, but the squat bar was actually a great place for her to rest her legs in between contractions.  Roslyn used the mirror for pushing too, and noted that this was a huge motivation for her and reinforcement for her to know she was pushing to the right place.  Roslyn was pushing effectively, but after an hour or so she was getting a little tired, and was having pain in her lower back and hip areas.  So between each contraction I got in there and provided heavy counter pressure on her hips and back with my full body weight and my fists.  Because she was pushing on her side I had complete access to do this for her and she said it was a big help in relieving the pain.  In a final effort to get baby to crown I pulled out a rebozo (traditional Mexican midwife scarf).  Roslyn held it on one end, and I was at the foot of the bed bracing myself and holding the other end.  With each push she pulled herself towards me with the rebozo.  This had the effect of concentrating her force down, and curling her upper body around baby to improve baby’s movement.  Within a few pushes we had hair, head, and had to call the delivery team in to catch baby.  Once the team was in place, Roslyn pushed twice more, and baby was out, pink, screaming.  Neil wasn’t keen on cutting the cord, but Roslyn asked if she could do it, and she did!  It was the first time I had seen mom cut the cord and it was very cool.  Their long-awaited baby was born at 5:52 PM on the due date no less.

Allison was the nurse assigned to baby at the time of delivery, another of my favorites at NAMC.  She is also studying to be a CNM, so she is very fond of midwife style birth practices.  She allowed Mom to keep baby on chest as long as she wanted, and did all of the medical examinations within Mom’s view, and had baby back to chest within minutes for full skin to skin bonding.  The nurses also offered to delay the bath a whole day so that baby didn’t have to stay for a prolonged period in the nursery without mom.  They also said that since Roslyn had such great mobility that they would be most happy to remove her epidural immediately, and wheel her anywhere she’d like to go so that she wouldn’t be separated from baby.

Many of the choices Roslyn made are not often standard with birth at a hospital.  (no imposed 24 hour labor limit, hands and knees laboring with an epidural, side lying pushing, no separation from baby at birth)  Because Roslyn had a well thought out birth plan and made her requests know to her nurses and doctors, and because she had an awesome team at NAMC, (aside from a close-call c-section), she was able to realize her birth plan wishes, from start to finish.

*Mom preferred to remain anonymous, but allowed us to post this birth story with the names of her and her husband changed.

Yesterday Stacy and Anthony welcomed their fifth baby into the world! I was there to help. Stacy did wonderfully, achieving her goal of avoiding an epidural even though she had pitocin.

Stacy and Anthony touched the hearts of all of us at Get Babied. After
four negative birth experiences, all inductions with very stressful
epidurals, we were all rooting for Stacy and Anthony to have the
natural birth they’d always hoped for. Because it was an induction,
this birth didn’t exactly follow the birth plan. Still, Stacy’s
determination, along with Anthony’s excellent doula skills and the
compassionate support of Stacy’s doctor and her team, enabled Stacy to
have a better birth than she’d ever thought possible.

Stacy and Anthony with Kids Jaxson, Lexie, Ryland, & Allie

When I met Stacy at 6:00 am at St. David’s Medical Center, she was
clutching a Dora The Explorer pillowcase and looking kind of worried.
She had experienced painful, discouraging inductions four times in the
past and expected today would be the same. One of her main worries was
that her trusted doctor, Dr. Mingea, would miss the birth if the
induction took too long. Fortunately for Stacy and Dr. Mingea, they
were able to share the experience together – for the fifth time.

When Stacy was first assigned to a room, she was disappointed that it
was pretty small. She knew she would have Anthony, her mom, and myself
attending, so a larger room with more than two chairs would be very
helpful. Because of her experience with this hospital, Stacy knew that
bigger and better rooms were available. Stacy didn’t want to cause
any trouble, but I encouraged her to suggest the room she wanted. When
she made the request to her nurse, Dr. Mingea happened to be walking
by, and the good doctor assured Stacy that they could accommodate her.

Five minutes later, we found ourselves in a rock star room three
times larger with seating for 7 and a huge wall of windows overlooking
a giant pecan tree that was home to a family of white-winged doves.
This was the first sign that Stacy would have an empowered birth
experience – for the first time at a birth, she asked for what she
wanted and got it. Anthony found some surgical tape and used it to
fasten photos of all their kids as babies, for Stacy to use as focal
points. I set out some lavender soap and lavender hand sanitizer, and
Stacy changed into the cute, comfy purple dress she’d brought to labor
in.

Stacy & Steph in Early Labor

Dr. Mingea had given orders for pitocin as soon as Stacy arrived, but
when the nurse, Sinead, checked Stacy’s cervix, she was already five
centimeters dilated and 80% effaced. She’d been using the breast pump
and walking throughout the previous day, trying to get labor started –
apparently it worked! She was further along than she’d been at any of
her previous inductions. Stacy knew that if she was on pitocin, she’d
be attached to the monitor as well as the IV. Since her goal was a
natural birth, she asked that Dr. Mingea try breaking her bag of
waters (called AROM, for Artificial Rupture of Membranes). If AROM
started her labor, then Stacy wouldn’t need to be continuously
monitored or attached to the IV. She also wouldn’t have to endure the
very intense contractions that pitocin can cause.

Dr. Mingea honored Stacy’s request, although she warned that if they
used AROM as a natural method of induction rather than the more
controllable drug pitocin, Stacy’s labor could take longer and Dr.
Mingea might not be able to deliver the baby. Stacy’s main priority
with this birth was that Dr. Mingea catch the baby, but she wanted to
try birthing naturally to have the ability to move about the room
without the monitor and IV. At 8:30, Dr. Mingea did a cervical check
and said that Stacy was dilated to 5 cm but would stretch to 7 cm. Her
bag of waters broke during the cervical check, so she didn’t even need
the AROM procedure.

Now, the plan was to remove Stacy’s IV and place a heplock instead, so
she wouldn’t be attached to the IV pole. She had to be on the monitor
for five minutes while standing, to ensure there was no risk of cord
prolapse. Stacy was thrilled because she hated the uncomfortable
monitor belts. Everything looked good after 5 minutes, so Stacy was
on intermittent monitoring – 20 minutes on the monitor, and 30 minutes
off.

Stacy, Anthony, and I took the opportunity off the monitor to walk up
and down the halls. We explored the entire third floor of St. David’s,
and Anthony took some video of our adventures. Stacy even walked up
five flights of stairs! When we came back to the room at 10:45, Stacy
had a quick snack and then it was time for another cervical check.
This one revealed the same dilation and station, but there was another
bag of waters! Sinead explained that this is a fairly common condition
where the bag has several layers and the AROM procedure ruptures the
outside layer, but there’s still a barrier between the baby and the
cervix that needs to be broken.

The three of us walked the halls some more, and Stacy noticed much
more fluid, indicating that the second AROM procedure really did
rupture the bag for good. The contractions came more frequently, but
they still weren’t very strong. After about 30 minutes of walking,
Stacy needed a rest, so we returned to the room for a game of
Outburst. We played until around noon, and Stacy and Anthony were
excellent competitors! Eventually, Anthony won, only because we had t
he topic “Famous Football Running Backs.” Otherwise, I would have
creamed him.

Anthony was so supportive throughout Stacy’s labor. With every
cervical check, he immediately moved to Stacy’s side and held her
hand. He encouraged her every step of the way, and reminded her how
great she was doing. During transition, he massaged her with cold
washcloths and reminded her to focus on her breathing. Stacy said he
had learned a lot from Susan McCutcheon’s book Natural Birthing the
Bradley Way, because he was much more skilled at comforting her than
he had been with the four previous labors.

Around noon, Dr. Mingea told Stacy that she wanted to start pitocin
because the AROM didn’t seem to be working to get Stacy to dilate
effectively. Stacy agreed to the plan, so she started the pitocin
around 12:30. After an hour, Stacy’s cervix was still the same. Her
contractions were even more frequent, but still short. Stacy tried to
catch a nap, since she had been too anxious all night to sleep. She
was unable to nap, but resting did give her a second wind. I stepped
out for some lunch, and when I returned, Anthony did the same.

Just a half hour later, around 2:00 pm, Stacy entered transition. She
became totally focused on getting through her contractions. I did the
double-hip squeeze, counterpressure on her sacrum, and massage to help
her stay comfortable. It took all the tricks I had, plus constant
encouragement, to keep Stacy focused and in control. Later she told me
that she had been repeating “Epidural…Epidural…Epidural” in her mind
over and over, and that helped her to stay calm and to remember that
there was an option for relief if she wanted it.

Just when I was starting to wonder if I should take a break from the
double hip squeezes to call Anthony, he came back from lunch. He
looked a bit startled to see Stacy’s labor so far advanced from when
he left the room about 30 minutes earlier, but he took it in stride.
He moved right to Stacy’s side, grabbed her hand, and started
encouraging her to keep going. She was beginning to feel out of
control, so his support was most helpful.

We tried several different positions, but nothing felt comfortable to
Stacy. She liked the squat bar but thought it was too much of a strain
for her legs, so the nurse suggested that she face backwards on the
bed while the bed was set up like a chair. This enabled Stacy to squat
in a completely supported way that didn’t strain her legs. Soon, we
could tell from the sounds Stacy was making that she was beginning to
push. She said, “I need to push! It’s burning!” and we knew then that
her baby was very close.

Suddenly Dr. Mingea came in, and I could tell that despite her pain
Stacy was relieved. Dr. Mingea told us later that she had received the
call to come as soon as Stacy’s labor was imminent, but everything
progressed so quickly that she had to run out of the doctor’s lounge
and only just made it in time to catch the baby . Dr. Mingea was calm
and encouraging, and she coaxed Stacy through pushing so gently that
Stacy didn’t tear at all with the 7 pound, 7 ounce baby.

When Dr. Mingea announced, “It’s a girl!” I admit I got a little
teary. We didn’t know until that moment whether baby Lexie Sage was a
girl or a boy. She was born plump and pink, with a perfectly round
head and red hair, just like her siblings. Dr. Mingea had Lexie placed
on Stacy’s abdomen right away for some skin-to-skin bonding. Stacy
told me afterwards that this immediate post-partum time was the best
she had experienced in her five births.

I’m so grateful to Dr. Mingea, Stacy’s nurse Sinead, and
everyone who helped Stacy through her labor without an epidural. Her
two main goals were to have Dr. Mingea there and to avoid the
epidural, and she was able to achieve both objectives!

Lexie Sage, born 8/6/2010

I had the honor of attending a beautiful birth on Monday.  Mama Sarah gave me permission to share her story. Sarah Sharp is a jazz singer and songwriter here in Austin – check out her website and go see her show sometime! Also, read Sarah’s testimonial about her birth experience.

Sarah called us at 4:30 am to let us know she was in labor. When I talked to her on the phone, she sounded happy and excited that she was finally going to get to meet her son Angus. I talked to her again at 5:00, and she was already heading to the hospital. Her contractions were fairly painful, and she was already 4 cm dilated before labor began. Since Angus was her third baby, she knew her labor would probably go quickly.

When I arrived at the hospital at 6:00 am, Sarah and her husband Andy were coping well with the contractions. Her cervical check showed that she was already 6 – 7 cm dilated. The contractions were short, but pretty frequent. Sarah liked to move around – she was constantly swaying, walking, and changing positions. She wanted suggestions for ways to move around that would make her contractions more comfortable and help the baby to descend.

The room was very bright when I got there – the fluorescent lights were glaring. We dimmed the lights, and when the sun came up we opened the blinds so that the natural light came in and we were able to turn the overhead lights off completely. Because the window looked out onto the roof, we didn’t have to worry about anyone seeing in. The view out the window was of some kind of weird boxy metal air conditioner thing. Andy took one look at it and said that if it was outside his window he’d put little arms and legs on it and make it into a decorative robot air conditioner thing. I liked Andy.

I asked if Sarah wanted to hear some music. She was up for it, so I played the Rachel’s station on Pandora with some little portable speakers I had. The mellow orchestral music and the lowered lighting really helped to change the atmosphere from a clinical hospital space to a serene, nurturing birth space.

I had brought my birth ball, and when I suggested Sarah try sitting on it, she found it very comfortable. I did the double-hip squeeze with the next contraction. It made a huge difference for Sarah; she said, “WOW! That REALLY helps.” I think from that point on, we did the double-hip squeeze on every contraction until the baby was crowning. Andy did most of the squeezing. After I had done a few hip squeezes, Sarah asked Andy to try. She gave very specific instructions for him as labor progressed, and he obliged for the rest of labor. By the time the baby was born, Andy was a pro. He swayed his hips when Sarah did, and he even climbed up onto the bed with her when he needed a better angle. Usually I’m the one doing the hip squeezing for hours at a time – Andy really made my job easy!

Sarah used the birth ball for most of her labor. We raised the bed and piled pillows on so she could sit on the ball and lean all her weight forward onto the pillows, concentrating on relaxing her entire body. She also liked standing next to the bed and leaning forward onto the ball. With Andy following Sarah’s strict orders about exactly how to do the hip squeezing, I sat on the bed by Sarah’s head and massaged her neck, shoulders, and hands. She breathed slowly and deeply with total control. When I noticed her clenching her teeth, tightening her shoulders, or holding her breath, I’d remind her to relax and inhale deeply.

At 8:00, Dr. Mingea did Sarah’s second cervical check. She was 9 centimeters dilated with a slight anterior lip, 90 – 100% effaced, and the baby was at +1 station. Her bag of waters was still intact. The nurse, Nancy, told us that we should call her as soon as Sarah felt an urge to push or her water broke, because once either of those things happened, the baby would be well on its way.

Twenty minutes later, Sarah’s contractions became very intense. She began trembling and had a harder time maintaining control during her contractions. I reminded her more frequently to breathe slowly and deeply and to keep her voice deep and low to encourage her cervix to open. At 8:20, Nancy checked Sarah’s cervix again because her trembling and vocalizations indicated that she was well into transition. Her cervix had not changed, and she still had no urge to push.

By 9:00 Sarah started talking to Angus, asking him to come down. She felt like he just wasn’t quite low enough. I suggested positions that would encourage her pelvis to open so that he could move into the proper position to fully descend. We tried marching with giant open steps, and we tried lunging. But Sarah didn’t like standing positions because during contractions she wanted to be seated on the ball with Andy doing the double hip squeeze. The seconds that it took to recognize the contraction coming, sit down on the ball, and order Andy to work his magic were simply too excruciating. Sarah wanted to use gravity to get Angus to descend, but none of the upright positions were working for her.

Since Sarah’s labor had been progressing so quickly until she reached 9 centimeters, I began to wonder if perhaps Angus needed more help rotating in order to move down. Around 9:30 I suggested Sarah get into a knees-to-chest position on the bed, which is one of the best positions to allow a baby to rotate. After about 5 contractions, Sarah felt the urge to push. We called Nancy immediately, and she stayed with us for the rest of the time. It became clear that Angus was definitely on his way.  Soon Nancy had Sarah panting in an effort to resist the overwhelming urge to push for as long as possible so that Dr. Mingea could get there in time to catch the baby.

When Dr. Mingea came in, Andy finally got to climb down off the bed and rest his arms. Sarah moved from hands and knees into a sidelying position. At 10:00 am, she pushed Angus out slowly and gently, with great control.

This was a lovely, calm, serene birth. Dr. Mingea and her team were always there if Sarah or Angus needed anything, but they were also happy to leave Sarah alone to create her own birth space and labor her own way. It was a delight to see how Sarah and Andy made their birth happen just how they hoped it would.

Sarah, Steph, Andy, and baby Angus, born 8/2/2010

 No we will not be flashing anyone:)

 just showing our community support for mothers who are giving their babies human milk.  Thanks for posting all the info Margaret!  We still have 2 more rehersals so come check it out.  We’ll have breakfast tacos and fruit ice pops on the day of the event to keep you energized and cool.  We’ve already received lots of media attention

KEYE interview

Here’s the flyer with the final rehersal dates.  I didn’t have access to edit the flyer but Newflower Farmers Market was also a generous contributor

flashmob flyer final

See you tomorrow.

Janet