Isabel's Birth Story

I was 39 weeks pregnant, feeling good physically and emotionally--better than I had for most of the pregnancy. Over the weekend, I started to get the feeling that something was going to happen soon. Isabel had changed the way she was moving inside of me. Instead of kicking, punching, and having "playtime" in there, it suddenly started to feel as though she was getting down to business. Her movements were more studied and intentional, like she was getting lined up for her big entrance into the world. She would move her little head back and forth, telling my body it was time to start opening up. She made little changes to her body position, making sure everything was just right for the big day.

Sunday night Doug and I went to dinner with friends, wanting to get in one last "grownup" excursion before baby became the primary focus for a while. It was a lovely evening, with yummy food, candlelit conversation, and good friends. We came home afterward, sat in our warm little living room, and basked in the afterglow of our beautiful evening out. I kept saying to Doug, "That was just what I needed." We went to bed in a happy glow.

Around 3:30am Monday morning, I woke up feeling a little "pop" inside of me. I sat up to go to the bathroom and felt some water run out of me. In the bathroom I saw part of my mucous plug, and I knew then that the length of time we would have to wait to see our little girl was growing short--little did I know how very short it would be!

I went back to bed, and I started having mild contractions twelve minutes apart, though I didn't really believe they were the real thing. I was able to sleep in between, so I just laid there and rested and felt very calm. Doug woke up a little bit and I told him what was going on, and we agreed not to get all worked up, but instead to go back to sleep and save our energy for the work that lay ahead. In retrospect, I realize that I was definitely having contractions and though far apart, they were already regular, but I was dealing with them so well that, being a first time mother, I kept second-guessing myself and thinking these couldn't possibly be REAL contractions. Maybe they were just intense Braxton-Hicks contractions? At any rate, I slept as long as I could and tried not to speculate on how much longer it would be before Isabel came to us.

In the morning, Doug went to Chick-Fil-A and got me a bacon, egg and cheese biscuit--my favorite pregnancy breakfast--and I devoured it with gusto in between the little contractions. I was still able to talk through the contractions, but they were starting to feel more intense, so I decided to call my doula, Teresa, around 10am. I realize in retrospect that because of my first-time-mom insecurities (and the fact I was handling the contractions easily) that I was reluctant to tell Teresa things were getting started, but deep down inside, I knew I was in labor. I was just scared to say "I'm in labor" in case I was wrong. Anyway, fortunately Teresa suggested I contact Margaret, my midwife, and let her know what was going on. Margaret suggested I come up to the office so she could check me and see if my cervix was changing.

Doug and I got dressed and headed up to the office on Howell Mill, which was a bit of a drive, but the contractions were still manageable, so it was okay. There were a lot of people in the waiting room, so we didn't get in right away. By the time Margaret checked me, it was around 1pm and I was 2cm dilated and 80% effaced. There was some uncertainty as to whether or not my water had broken (I never had the big gush, but had been leaking clear fluid pretty constantly all morning) but Margaret didn't seem concerned so we didn't worry about it. So things were happening, but it looked like we still had a long time to go before baby. Margaret said maybe she'd see us later that night, and we were thinking maybe we'd have the baby the next day. At the advice of Margaret and Teresa, we decided to continue doing what we were doing--just going about our normal day, and not timing contractions until they were so strong there was nothing I could do but time them.

We were getting hungry, so we thought we'd stop off and get one more good meal inside of us before things got more intense. We stopped for my favorite pregnancy lunch--Pad Thai from Doc Chey's--and got it to go. The girl at the cash register noticed me breathe through one of my contractions and asked if today was the day, and I told her we thought so, and she congratulated us and I felt so proud and excited about what we were about to do, I wanted to tell everyone! While we waited for the food to be ready, I sat outside on a low wall, basking in the beautiful fall sunshine and feeling the cool breeze, and being so happy to be alive and doing the amazing work of bringing a child into the world. The contractions were getting more intense, and when Doug came out with our food, I leaned on him and we breathed through one together--the first one I'd needed help to get through. I had no idea this was a sign of the major ramping up in pace that was about to occur.

We got in the car and on the way home I said to Doug what a gorgeous day it was and how when we got home I wanted to sit out on the front porch and eat my noodles and then maybe we could labor outside together for a while. He said that sounded like a good idea if it was what I felt like I wanted to do, so it was settled.

By the time we got home, everything changed. Contractions were suddenly no longer manageable while going about normal activities. It was like a switch had been flipped, and I was no longer in early labor, I was in active labor. I had to stop everything to deal with the contractions and they started to hurt a lot. Needless to say, I didn't eat any of my noodles, and I didn't sit on the porch and I didn't enjoy the sunshine. I got in bed and I started to struggle through the contractions deliberately, breathing and trying to relax my abdomen and just let myself open.

At my insistence, Doug wolfed down his noodles (I wanted him to have energy for the journey ahead) and then came to the bedroom to be with me and help me through contractions. He did such a good job, I get all emotional when I think about it now. We did some of the things we learned in our birth class, but mostly he was just there with me, and we were connected, not just here in the physical world, but also on a spiritual plane that is difficult for me to explain. But we were there together, and I felt our connection stretch into infinity, and I felt so loved and held and protected by him and it was so beautiful. This middle part of my labor was very short, but I will treasure it for the rest of my life as the most special moment Doug and I have ever shared. He laid in the bed with me and held me, and I held onto him and we rode the waves together. It was so very very short, and I wish it could have lasted longer, but I'm so grateful that we got to share that time at all and I would not trade it for anything.

And just like that, the switch was flipped again and we catapulted into the next phase of labor--transition. Only we didn't know that's what had happened. You have to understand that all through this experience, our brains were in one place, and my body was in another, and it wasn't until after all was said and done that we realized what had happened. There I was working really hard, contractions coming one on top of the other, the pain never really letting up in between, and Doug and I were still trying to breathe and relax through them like it was early labor, and frankly starting to get scared that things were quickly becoming too intense to handle. We tried and tried to time the contractions, but I was getting little ones and big ones, and they were all over the place time-wise, and the pain never really let up in between, so we couldn't establish a pattern and when Doug called Teresa and Margaret to tell them there was no pattern, they quite understandably assumed that there was no way a first time mom had dilated that quickly and told us to keep doing what we were doing and stay put at the house. So we did.

And I got more and more scared. At some point, I remember looking at Doug and telling him I was terrified, and I know he tried to reassure me, but I don't really remember what he said anymore because by this time I was in another place entirely. My brain split into two--there was my rational, logical, "modern" brain, and then there was my primal animal brain. The primal brain was taking over, and the logical brain was drifting to the background. The logical brain still interjected comments from time to time, but was mostly playing second fiddle to the primal brain, which now had me kneeling on the bed or the floor and roaring my way through contractions. Doug could no longer do anything to help me through them, and my logical brain felt so bad for pushing him away, not wanting to hurt him or keep him from performing this role he'd been getting himself ready for. But the primal brain was now in charge, and she said there was no breathing through this, there was no relaxation, no being touched. All that was left was to get on my hands and knees and roar the baby out.

Part of the reason I was so scared is that I didn't know when we should go to the hospital. In retrospect, I realize we should have gone to the hospital well before we did, but as I said, we didn't realize how rapidly I had progressed. I just thought I was doing a really bad job of dealing with regular contractions, not that I was actually doing a GOOD job of dealing with transition. But I was afraid, and I know that made the pain worse. I knew as time passed I was getting into more and more of a state where I wouldn't be able to tolerate the journey to the hospital and I was worried we'd have the baby at home. I don't remember exactly how the decision was finally made to go to the hospital, but Doug made the phone calls to Teresa and Margaret because I was way past being able to talk on the phone. Doug tried to get me dressed, but with each contraction my clothes became more intolerable and I kept ripping them off myself and getting down on my hands and knees. I realize now that I was experiencing an intense urge to push, but at the time I just knew that every time I tried to relax into a contraction, I felt a sense of panic and pulled back in instead. I think my instincts were working to slow me down and keep me from having my baby there on the bedroom floor!

Finally Doug found me my purple cotton dress to wear, since clearly I was not able to keep my pants on. Doug got the bags loaded into the car and moved the car seat out of the back. I did NOT want to get in that car--I knew it would hurt so much more in the car, and I was scared to make that trip, but I knew that for my baby to be safe, I really needed to do it, so that's when I started to pray.

I started out asking for strength and courage and guidance. I asked for these things over and over again, at first under my breath, but then out loud, and it became my mantra I repeated to myself, as Doug helped me climb into the car.

Doug made the drive as quickly and smoothly as possible, but it was hell. I had to bring my logical brain to the fore from time to time and give him directions ("turn right at the cemetery", "go under the blue bridge and turn left") because we had never gotten around to doing our trial run to the hospital--and every time I had to bring forward the logical brain, the pain was worse. Then I would switch back to the animal brain and I would howl and grunt and go back to chanting and praying.

I called on the gods and goddesses, and my ancestors. I believe a part of me needed to be mothered at that moment, because I asked Freya to hold me and cradle me and give me strength. I asked my female ancestors for guidance in bringing the next in their line into the world. I asked for courage to do the work required of me. And in the middle of all of that, somehow I received a message. The message was: "It has to hurt to mean something. If it wasn't hard, it wouldn't be worth doing." And I found strength in that, and realized that, even though it was hard, I was safe and my ancestors were there with me in that moment, and my children and my children's children were also there with me in that moment, and it hurt, but I would not break and I would make it through.

To anybody in a car passing us, it probably looked as though I was out of my mind with craziness, writhing around in the back and yelling and chanting and praying. But actually it was then that I started to pull myself together. Those things that seemed crazy were actually me centering myself and pulling on reserves of strength that I wasn't aware I had.

When we arrived at the hospital, I had to help Doug figure out where to park and how to get into the hospital--I cannot emphasize enough how important it is to do a trial run of this sort of thing, and I will definitely plan better next time! But we managed it. We didn't bother waiting for a wheel chair for me--we didn't have time, and I wouldn't have been able to tolerate contractions sitting down, and besides, I was determined to walk in there under my own steam. We made it up to the 7th floor (thank goodness for elevators!) and stumbled up to the reception desk, and I feel bad for the cleaning crew because I was leaning my head and face and hands all over the glass window, propping myself up while they got me admitted. But these people knew their stuff, they could tell I was late in labor and in no fit state to sign waivers and the like. They immediately got me into a room.

Margaret showed up not much later, but by this point time meant nothing to me, and I have no idea how quickly it all happened. People were bustling everywhere around me, but I didn't know what was happening outside of my own little bubble. I know the nurse asked if I wanted to put on a hospital gown and I said I'd prefer to keep on my dress. Then at some point I know I had to get out of my dress, and two people helped me--possibly Doug and the nurse? I don't know. Margaret checked me and announced I was 8cm, and I have never been more relieved in my whole life. If I had been less far along, I would have known there was no way for me to make it through the rest of the process. But knowing that I was right there, right at the worst part of it, that this was the worst it was going to get--that's what allowed me to keep going.

They started to get the birthing tub inflated and filled up. The nurse was trying to monitor the baby, but I couldn't stay still long enough to keep the monitor on. I writhed around and I remember whining something about "it's so bright in here..." and they cut off the overhead fluorescent lights and I was SO grateful. i know I was also bitching about how they needed to hurry up with the tub, and how the damn monitor band needed to come off my belly NOW. They were so good to me, and the nurse took off the monitor and they switched to intermittent monitoring, and I'm pretty sure they fudged the rules for me because they're not supposed to let me in the tub until the baby has been continually monitored for a certain amount of time, but they could all tell where I was and they took care of me right. I don't know what I did or said to cause it, but at one point I remember Margaret saying "and that's how we know she's in transition" and the other people in the room laughed. I don't know who all was in there--it seemed like so many people, but I just shut it all out and went with the contractions, and Margaret started coaching me through them, urging me to grunt low. Sometime in all this mayhem, Teresa arrived, of which I was vaguely aware, mostly because my logical brain (which was now completely in the background) was thankful she was there to reassure Doug. I knew he must have been terribly worried and felt things were out of his control, and I was thankful when I saw Teresa put a reassuring hand on him from time to time.

After what felt like hours, but I now know was quite a short time, they had the tub inflated and filled enough for me to get in. When I did, it was the most blessed feeling of relief, I can't even explain. I'm sure if we'd realize a few hours ago we were progressing quickly and I had been able to labor in that tub most of the time, I'd be telling a very different story now about a more gentle birth experience. But as it was, I was thankful beyond belief even for the few minutes I did get to spend in that tub. The warm water and buoyancy gave me the comfort I needed to push through the last little bit of labor. I was able to get on my hands and knees and be comfortable, and between contractions I could lean against the soft walls of the tub.

When my baby started to come down the birth canal, I reached down with my hand and touched her, felt her tiny head coming out, and that was all I needed to keep going. Doug held me in his arms there at the side of the tub, held me so tight, and even though I was still in my primal brain, I was there with him, and he was with me, and he gripped me and sent me his love, a palpable force which I could feel as I pushed our daughter out into the world.

Isabel Ivey was born at 7:12pm, into a tub of water that had just barely finished filling. She was not born on the bedroom floor because her daddy was strong enough to help me into that car when I didn't want to go. She was not born in the car because her momma somehow knew not to push yet, even though I wasn't even aware it was pushing I wanted to do. And she was not born on the hospital bed because the life-giviing sound of the water pouring into a tub gave her mom the patience to hold on just a little longer.

No, Isabel came into the world in a warm, watery dimness, as gently as her momma could manage, given the circumstances.

I felt her slide out of me, like a rubbery cork, and I breathed a sigh of relief and I don't know how I got into an upright position, but I did, and I held my baby there in my hands and she had her eyes wide open and gazed into mine, and she was so alert, and started to turn pink right away, and I just knew she was okay and had come through the journey safely. I held her for a while, and I don't remember what I did or said. I just remember wanting to memorize everything about her, down to the way the umbilical cord looked attached to her body and the way the vernix felt on her skin. I wanted to remember it all before it all changed, before cord-cutting and tests and baths and time rushed us away from that moment. I held her little purple sticky wet body in my hands, and there in the dimness I fell in love.

Doug cut the umbilical cord and after what seemed entirely too short a period of time, they took my baby from me and helped me out of the tub. I immediately started shaking uncontrollably, partly shivering with cold, and partly reeling from the intensity of the experience I had just had. They wrapped me up in warmed blankets, and helped me to the bed, and it was only then that I finally started to be aware of the people around me. Doug was at one side of me, and Teresa at the other, and Margaret and the nurse were at the foot of the bed as I delivered the placenta. Afterwards they let me see it, and Teresa even took pictures of it for me, and it was beautiful. Teresa showed us how it had a Tree of Life in it, and Margaret showed us where it had attached to my uterus to transfer life to my baby. It was amazing.

The baby was never more than a few feet away from me while they checked her out to see if everything was okay, and Doug says that whenever I talked she would turn her head in my direction. When they put her back on my chest, she laid there and I was amazed at how strong and alert she was. She could lift her little head up and push herself around with her feet, and her eyes were wide open and she looked at everything around her, most especially focusing on my face. I'm so grateful we got that period of quiet alertness that comes with a non-medicated birth. It was priceless.

I have a tendency to doubt myself, and because during my labor I felt such intense pain, I thought it meant I was weak and not managing well. But I realize now that a hole inside of me opened up, and did so much more quickly than it usually does for most women, and that when things progress that rapidly, it hurts more. And considering how I breezed through early labor, I realize now that I dealt with the sensations very well indeed, and I'm proud of myself. Several people have said to me after the fact "Oh, you're lucky it went so quickly", not realizing that the faster passage also means more intense sensations. But I know, and Doug knows because he was there, and we know that my shorter journey in no way lessened the intensity of my ordeal. It just made it different. My rite of passage was mine, and I lived up to the challenge. I know now what I'm made of and what I'm capable of.

We spent our first night with the baby in the hospital, and in the middle of the night, while dad slept in the cot next to us, Isabel and I laid in the bed together, in the dim orange glow of the city lights, and she stared into my eyes and I stared back. It felt like all of eternity was encapsulated in that one night, in my little girl's eyes. As exhausted as she and I both were by the experience we'd been through, I think we both could have laid there gazing forever if we'd been allowed to.

When we left the hospital two days later, the hospital people insisted they bring me a wheelchair to ride down in. I was resistant at first, just because I was impatient and waiting around for a wheelchair seemed silly when I could walk perfectly fine. But as I rode along in the chair, followed by the hospital person pushing it, and my parents walking along after him, cradling my new baby in my arms, I felt a sudden surge of pride. People looked at us as we went by, commenting on how cute my baby was, or stopping to congratulate me, and I felt triumphant. The wheelchair didn't make me feel weak, it made me feel like a triumphant queen on a litter!

And then, when Doug and I pulled into the driveway of our happy little house, I looked out of the car window and saw my front porch, decorated with bouquets of flowers, and teddy bears, and balloons--congratulatory gifts people had sent to greet us as we arrived. And I carried the fragile little bundle of my baby into our living room, and I sat on our little couch, and I told her "Isabel, this is your home now" and I burst into tears and finally all the emotions of the last few days became real and came pouring out of me, and I told Doug "We're a family now. We were partners before, but now we are a family".

Nearly a week has passed now since the birth of our daughter. Her wrinkly, funny looking little face has filled out and pinked up and turned into the most heart-wrenchingly beautiful thing in the world to me. We are bonding with reckless abandon, nursing constantly, snuggling in between, and drinking in every moment of togetherness we can. Dad takes care of us both, bringing me food and drinks, changing Isabel's diapers, and lavishing us both with kisses. I know eventually Doug has to go back to work and I have to do things like laundry, and every day won't feel quite this blissful, but I don't think I have ever in my life been happier than I am right now.

Psychotropic Drug Use During Breastfeeding

Psychotropic Drug Use During Breastfeeding: A Review of the Evidence
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326

OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy


I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”

And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.

The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”

What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.

“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”

This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.

“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”

Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”

I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.

The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”

But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.

The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.

I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.

Teresa Howard

Neriyah's Birth Story

Months of preparation finally became real on the morning of October 2, 2009. Nyokabi had a restful night and was ready for the day. After Morning Prayer with Jonathan, she decided to call Baby Depot to check on the special delivery of a hutch that she ordered for the nursery. After being on the phone with them for 15 minutes and not getting anywhere she started to get frustrated when she felt her first contraction. She knew right away that labor had started so she ran to tell Jonathan that her contracts had started at 10:56AM. After experiencing irregular contraction for about 30 minutes Jonathan calls Persis, their doula, to let her know today was possibly the day. Nyokabi told her that she saw part of the mucous plug and the contractions were not in any real pattern yet. However, 20 minutes later, Jonathan calls Persis again to let her know Nyokabi has a heavy show off blood. At this point Nyokabi starts to worry so Persis decides to come to the house just in case the labor was going fast.

Persis arrives at 12:23pm. Nyokabi answers the door with a beautiful smile and a big hug. She is excited this may be the day and wonders what she should do next. Persis suggests she continue her normal day. Jonathan makes lunch while Nyokabi finishes up her last day at of work while sitting on her birth ball. We all watch “7 pounds” with Will Smith. Nyokabi rocks with each contraction and stays hydrated as she finishes up her last day before maternity leave. She was determined to finish a project and get paid for her last day of work before her leave. After lunch Jonathan runs an errand and Nyokabi has a craving for pancakes and decides to make them as she continues to breath and rock through her contractions. Nyokabi starts to wonder how long will labor last and Persis reminds her of the marathon analogy for labor so she tries not the think about the time. The contractions are getting stronger, but Nyokabi stays positive and laughing.

At 4:00pm Nyokabi goes upstairs to take a bath for relaxation and her contractions starts to slow down significantly. So she gets out of the tub and stays upstairs for the remainder of the night in her room where she rotates between the rocking chair and the bed. Nyokabi even manages to take short naps in between the contractions. Persis stays near by in the upstairs sitting room as Jonathan prepares the home for the Sabbath. At 9 pm Persis suggest they all rest for the evening so Jonathan sets up the guest bedroom downstairs. Nyokabi continues to remain quiet in her room with contractions in a somewhat consistent pattern. Jonathan stays close to the room but continues to occupy his time around the house. At 10:00pm Jonathan reports the contractions are no longer in a pattern and Nyokabi is complaining of back pain. Persis suggests she get in knee-chest position to help ease the pressure on her back. At 11:00pm with the back pain still present, Persis reminds Jonathan to rub her back. Nyokabi’s contractions gets intense and she feels like she has to vomit. Within 30 minutes Nyokabi can no longer be consoled and suddenly she is at a loss for words and can not communicate what she wants other than wanting to go to the hospital. She does not want to be touched, talked to, or questioned as she is now unable to express herself through the intense contractions. Persis suggest she get in the bath while Jonathan gets the car ready for them to leave for the hospital. Nyokabi’s contractions are now coming very close together and as soon as she gets in the tub Nyokabi could no longer resist the urge to push. Persis works to calm her down and quickly gets her out of the tub and bathroom but Nyokabi is still pushing because she can not control the urge. Persis yells for Jonathan to move quickly and starts to refill the tub just in case the baby’s head crowns. Luckily the decent of the baby is slowed and they are able to get downstairs and in the car quickly.

They pull out of the driveway at 12:21am. Persis advises Jonathan that he needs to get to the hospital as fast as possible so he drives nearly 85mph while breaking several traffic laws to get there before the baby starts crowning. The hospital was only 4 miles away but the drive seemed like an eternity to Nyokabi. She continues having contractions and pushing in the car as she squeezes and bites Jonathan’s arm to help her deal with the discomfort. Jonathan calls Nyokabi’s obstetrician (Gwinnett OB/GYN) to let them know that she was in labor and was starting to push. He got an answering service and left a message for them to call him back.

They arrive at 12:30am and Jonathan drives frantically to the entrance of Emory Eastside Medical Women’s Center. Monique, a postpartum nurse, was outside saying goodbye to her daughter when Jonathan pulled into the women’s center. As they approached the entrance, Nyokabi yells to Monique “hit the blue button!!” This is to let the labor and delivery department know it was a “cold blue” emergency. She hit the blue button and quickly brought a wheelchair as the labor and delivery nurses arrived prepared to assist with the delivery. Jonathan lets Nyokabi out of the car to the care of the nurses while he went to park the car when he gets a call from Dr. Traci Johnson (the OB on call for Gwinnett OB/GYN). Dr. Johnson starts to ask Jonathan questions to find out the status of Nyokabi’s labor. Jonathan tells Dr. Johnson that Nyokabi is pushing but Dr. Johnson did not seem convinced as this was her first baby and her water had not broken yet so she informs Jonathan that she will be there shortly. By then Nyokabi was wheeled to the birthing room and within minutes where the nurse confirmed she was fully dilated and the baby was crowning. So the nurse called for the birthing team to come in and assist with the delivery. When another nurse decided to check Nyokabi her water suddenly broke without notice at that point Dr. Johnson arrived to assist as Nyokabi continued to push. Dr. Johnson says to Jonathan, “Wow I guess you knew what you were talking about!”

Once Nyokabi was flat on her back she was told to push and at 12:39am on October 3rd, after 4 pushes Neriyah was welcomed into her new world. Nyokabi feels an immediate feeling of calmness come over her and says to everyone, “I can’t believe I did it!” She was able to accomplish her goal of having a natural childbirth.

Pediatricians- Not a Good Resource for Breastfeeding Information

Pediatricians’ Practices and Attitudes Regarding Breastfeeding Promotion
Richard J. Schanler, MD*; Karen G. O’Connor‡; and Ruth A. Lawrence, MD§
Pediatrics 1999;103;e35

ABSTRACT. Objective. Public awareness of the benefitsof breastfeeding is expected to increase during and after the national,federally funded Best Start BreastfeedingPromotion Campaign. It is anticipated that this will resultin more breastfeeding-based interactions between families and pediatricians. The American Academy of Pediatrics conducted a survey of its members to identify their educational needs regarding breastfeeding to assist in the design of appropriate information programs. Method. An eight-page, self-administered questionnaire was sent to 1602 active Fellows of the American Academy of Pediatrics. Results. The response rate was 71%. Breastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year. A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula- feeding are equally acceptable methods for feeding infants. Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding. The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative. The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years; most said they wanted more education on breastfeeding management. Conclusion. Pediatricians have significant educational needs in the area of breastfeeding management.

This study is one that is actually quite humorous to those of us who work with women who are nursing and have an issue that takes them to the average pediatrician. We understand not only the lack of information or education a pediatrician has regarding breastfeeding, but also the level of influence they still have on the breastfeeding relationship. Ironic that a non medical issue is one that parents still seek out medical opinions for.

This study cited that even though the big boy club of the AAP themselves promote breastfeeding as the best form of infant nutrition and encourage the infant to be fed that way, the very members of this association are failing miserably at conveying correct information to their patients parents. If the hospitals are not screwing up the relationship fairly quickly in the postpartum period, then the doctors then do their own lack of encouragement.

This study was timed to ascertain the physicians influence on breastfeeding as federally funded Best Start Breastfeeding Promotion Campaign was launched. “This campaign is targeted initially at 10 states to raise public awareness of breastfeeding through pre- and postnatal parent counseling and media promotion. Increased public awareness is expected to increase breastfeeding-related interactions between families and physicians.” They wanted to know how many of the doctors in the areas were going to be supportive of this endeavor and if they needed to do anything to help make this more likely.

The good news is this study was to “to assess breastfeeding attitudes, knowledge, and management skills of pediatricians, as well as awareness of their hospitals’ breastfeeding promotion activities. Results from this survey are expected to help in the design of appropriate breastfeeding education programs for physicians.” The bad news is the majority of the doctors definitely need more education in this area!

The conducted this study by first giving a survey to the physicians- mostly located in urban areas. The solo and group practices had better breastfeeding initiation and continuation than the clinic physicians. Tragically, only 65% of the pediatricians’ recommended exclusive breastfeeding to new parents during the early weeks of their infants’ births. 13% recommended formula supplementation while actually 2% said formula feeding was ideal. Although the AAP takes a stand on duration of exclusive breastfeeding being recommended for at least six months only 63% made any recommendation regarding duration. And only 31% made the recommendation that AAP suggested. But to be commended are the 61% who suggested the ideal time of at least one year.

Establishing breastfeeding and bonding time with the infant in the early hours after birth is a known factor in helping to increase breastfeeding success. Yet the doctors varied in their initial recommendation to do so. Only 44% recommended that the mom initiate breastfeeding in the first half hour after the birth. Only 59% suggested that demand feeding be established. Almost a quarter of the physicians were not opposed to formula or water be given to the breastfed infant. And keeping the mom and baby together by rooming in was equally divided in the study.

The use of pacifiers was only discouraged by a fourth of the doctors until breastfeeding was established. And the introduction of solids was not at the AAP recommendation either. Many recommended solids at a much younger age than 6 months. As this study states, “These infant feeding practices are known to impede successful breastfeeding and may be unnecessary.”

It was no surprise that in an office several people could be called on for phone consultations to assist new parents with breastfeeding questions. Only 76% of the time it was the doctors- who have proven they were not following suggested guidelines. Fewer than a quarter actually had lactation consultants. And few even knew how or if the staff that supplied information had ever been trained in the area of breastfeeding. Is it no wonder that misinformation was being handed out?

Only 58% of the actual physicians themselves had ever had any education regarding breastfeeding. The younger physicians (under 45 years of age) were more likely than the older physicians. And the female physicians had more training than their male counterparts. And yet although they mostly said they wanted to learn more and had not had sufficient training, 77% said they felt competent to manage common breastfeeding problems. Based on their lack of training or education in the area, it makes you wonder other areas they feel competent managing where they may also lack training and expertise.

It is no wonder that only 60% of the pediatricians had children of their own who were breastfed! Those with no personal experience were more likely to not recommend breastfeeding if the moms had common problems like breast or nipple problems- this was at 37%!

It is also no wonder that few hospitals are meeting the standard of Baby-Friendly Hospital Initiative since 72% of the doctors were unfamiliar with this initiative as well as the Ten Steps to Successful Breastfeeding statement. How can they be supportive and help promote these ideals if they are unaware of what they recommend? More then half of the doctors were unsure if there was a written policy regarding breastfeeding and if there was one what was stated within it.

The study stated, “These data suggest that the lack of clear recommendations may lead to confusion when parents question physicians about breastfeeding.” I find this an understatement. It also uncovered that very few pediatricians were even seeing their patients’ parents prenatally- where good information regarding breastfeeding could be conveyed.

The study was effective in uncovering the strong need to get the pediatricians on board with promoting breastfeeding. Helping parents prepare, initiate, be successful and continue to breastfeed is certainly an area where pediatricians can make a huge difference. But we need to get them up to speed on how to do this and it begins with more education.

Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE

Does Income Affect Breastfeeding.... Does a Mom's BMI?

Maternal Variables Influencing Duration of Breastfeeding Among Low-Income Mothers
Anne Chevalier McKechnie, RN, IBCLC, RLC, Audrey Tluczek, PhD, RN, and Jeffrey B. Henriques, PhD
ICAN: Infant, Child, & Adolescent Nutrition June 2009

This is my review of their study….

Who breastfeeds longer? The study was performed on low income moms. The lack of long term breastfeeding is highest in this group. What the findings showed was that moms who had a high body mass index also fed for a shorter period of time. And the moms who fed longer were also moms who breastfed more exclusively. Younger moms did not nurse as long as the older moms in this study as well.

The study was done in hopes to figure out how to improve the outcomes for breastfeeding moms to nurse for a longer period of time. It stated, “US Department of Health and Human Services established the following goals for breastfeeding by the year 2010: a 75% rate of initiation, a 50% rate of breastfeeding for 6 months, and a 25% rate of breastfeeding for 12 months.“ They set a goal to lengthen the duration of breastfeeding and to help moms exclusively breastfeed.

So, let’s look at this study. It makes sense that if you begin weaning- and weaning meaning putting anything in the baby’s mouth besides the breasts- that the breastfeeding duration will be shortened. Many mothers do not realize that sucking needs are normal and should be met at the breasts as often as possible as to increase milk supply. Instead they begin using a pacifier too quickly and too often and wonder why their milk supply dwindles. They also think that just one bottle will not make any difference to their breastfeeding relationship. It does. One bottle quickly becomes more and soon others are feeding the baby and we are trying to pump to keep our supply going when nursing would automatically do that.

Poor women are more susceptible, I suspect, since often they are forced into the work environment to survive and our government assistance offers them free formula in order to feed their baby instead of a stipend to stay home and nurse. When my own daughter qualified for the WIC program I was amazed out how often she was encouraged to take the formula they offered and start supplements sooner. So, I was not surprised to find this study also showed, “Many mothers in low-income populations participate in Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs, and numerous studies have shown that these mothers are less likely to breastfeed as compared with nonparticipants of WIC programs.”

I believe these women are also often encouraged to start solids sooner. The concern I am sure may be that the women themselves have poor nutrition, thus breast milk is compromised. But instead of providing the mom with better nutritional guidelines, the suggestion is made that she offer her infant something that is less nutritious than nursing her baby. This study indeed showed how, “the highest risk for poor health, tend to have the lowest breastfeeding rates.”

The other part of this study looked at how the B.M.I. of women affected their breastfeeding relationship with their babies. “Obesity may also adversely affect breastfeeding in several ways. First, mothers with a BMI at or above 30 kg/m2 may experience hormonal patterns that interfere with milk production.30-32 Second, the infants of obese and overweight mothers may have physical difficulty latching onto the breast.31 Finally, an elevated BMI may indirectly interfere with the initiation and duration of breastfeeding because obesity is also associated with complications of pregnancy and delivery, cesarean delivery, poor maternal self-esteem, maternal depression, and low socioeconomic status. A recent study34 found that mothers with a BMI ≥25 kg/m2 were more likely to have discontinued breastfeeding before 6 months than normal-weight mothers.”

I tried to think about how this factored into the relationships of moms and babies I had worked with over the years. Indeed I saw more women who were considered overweight having complications with their pregnancies. These complications did lead to more surgical births as well as inductions and the edema that inductions sometimes caused in the moms causing latch issues initially. I have not seen the hormonal shift issues but certainly can see where an out of balance hormonal issue can cause milk production issues as well. But recently I had a client who is obese have real issues with her third baby. She found herself unable to successfully breastfeed outside of her own home environment due to how she had to work to latch her daughter onto the breast. It was not something she could do easily or even the least bit discretely.

New moms are concerned with body image as their breasts are larger but their bellies are still on the post pregnancy form- and therefore they want to hide their bulges and are learning to manage the new larger breasts. This makes them uncomfortable initiating breastfeeding in many situations outside of their home. Part of this is how we make women feel about their bodies in general in the USA and how we make breastfeeding a sexual act instead of a natural one. But certainly not feeling good about our bodies makes us not feel good about some of the natural body functions we may have as well. Our environmental support systems are certainly lacking in regards to support for breastfeeding.

This study had a hypothesis of, “Mothers within a low-income population who chose exclusive breastfeeding would likely (a) continue breastfeeding longer than mothers, who chose partial breastfeeding, (b) be of an older age than mothers who chose partial breastfeeding, and (c) have a lower BMI than mothers who chose partial breastfeeding.”

The other factor that was mentioned in this study was age. The younger moms seemed to lack the support of their community in breastfeeding and therefore initiated breastfeeding less as well as length of time of breastfeeding was limited.

The study concluded with this statement, “Breastfeeding is a complex issue with lifelong consequences for both mother and infant. This study found that factors, such as exclusive breastfeeding, older maternal age, and lower BMI, were associated with longer breastfeeding duration. These findings move us closer to understanding the unique needs of low-income, WIC, breastfeeding mothers and support the notion that maternal readiness and capacity for breastfeeding are influenced by dynamic biopsychosocial processes.”

I wonder if we had more pictures of younger moms nursing their babies in ads, women who overweight were nursing their babies, and moms in general nursing in more public areas in ads and government promotional materials, if we would increase these numbers for both initiating breastfeeding as well as duration of nursing exclusively. I wonder if we increased awareness to the communities of the benefits of breastfeeding if we would see the support change in the communities to support all women and babies in breastfeeding.

When as a lactation educator I am still counteracting the negative and detrimental things that are being done in the hospitals to sabotage breastfeeding, in the WIC offices to undermine the moms and in the communities that still want to banish women and their nursling to the bathrooms to nurse, if BMI and socioeconomic conditions are just a drop in the bucket as to why breastfeeding numbers are dwindling in the US.

Teresa Howard, CD (DONA), CLD, CLE, CCCE (CAPPA), CHBE

Melia Gives Birth

Melia had her first baby using pain medication- I can't remember the details- hopefully she will share them in the comments... She then took my childbirth class and hired one of the LOL doulas and had a home birth. This time she hired a local doula- an excellent one I might add- and took the Birthing Again classes that I teach. They chose to give birth at Athens Regional using the wonderful midwifery group that supports women there. I read her birth story and asked if we could please post it here to share with you. She happily agreed!

The Birth of Della Ruth Digby

I sit here with my four day old daughter on my shoulder, sleeping peacefully. The mere thought of her still seems very surreal to me. I have a daughter. Della Ruth. Oh, how I love her and know her already.

Her birth story really begins in October 2008. For the years following her brother Erick’s birth, her pop and I had always felt we were done having children. We had two beautiful, wonderful boys. It was enough. Or so we thought.

One afternoon in October, I was dancing in my bedroom holding young, 2 year old Erick in my arms. We were listening to. “I called my daughter, called her by her little name…” and I had this overwhelming sensation, this knowing, I have to have a daughter. In that moment, I believe, Della Ruth and God called to me, and I answered.

I called my wonderful husband, Rick. I said, “I want a daughter.” He said “We’ll talk about it when I get home.” And we did. He walked in the kitchen. We hugged and kissed like always and I said again, “I want a daughter.” He said, “It might not be a girl.” I said, “We have to try.” And the miracle of it was, he said “okay.”

Never before had we been in this place regarding another child, and so to both be there, at the same time, well, I knew...this child is meant to be.

We spent the next two months almost giddy with anticipation and love. And on Christmas Eve, around midnight, I took a pregnancy test. And it said “pregnant!” I just stared and stared at it. I was on the phone with my sister, Lindsay, when I took it and we were so very thrilled together.

That next morning (I could barely sleep that night!) I gave pop an ornament with the date 9.09 on it along with the positive pregnancy test. Oh, how thrilled and excited we were!

The pregnancy progressed (oh how sick I was!) and at 20 weeks, we chose not to be told our baby’s sex at the ultrasound. We had found out with the boys, and I wanted this time to be different. Also, a part of me knew that I would love love love my child regardless, and rather meet my child and find out than be told by a technician. Everyone seemed to say “boy” (strangers, coworkers, etc) based on how I was carrying. I didn’t really know. I trusted, though, that whoever it was, Della or Seth, it was the child who called to me. So it didn’t matter.

My due date was September 5th, and that came and went. On Thursday, the 10th, my irregular Braxton Hicks contractions seemed to have more pressure to them, and began to involve my back. It was late, about 11 pm. Rick and I were watching television. I got up and told him that I thought I’d be having the baby in the next day or so. I went to the bathroom and before I even removed the toilet paper, I knew it would show some indication of birthing, and it did. Bloody show. How exciting!

I called Lindsay and told her to plan on coming in the morning. I texted my doula, Alexa, and told her I’d call in the morning. All night I woke up every 10 minutes or so with contractions that felt similar to menstrual cramps. They were quick and easy, but they kept me awake for the most part. I listened to some Hypnobabies and tried to rest. In the morning, we woke the kids up around 7:00. I told Lucas first, and he was so excited (about the birth and about missing a day of school!) How they had been waiting for this day! I woke up Erick and he wanted to come with me, to stay with me. We got him excited by packing his book bag full of books to take, and I got a picture with the boys cuddled with me. Our last picture together before Della. Rick took the boys over to Grandma Rosie and Grandpa Johnny’s condo. They were very excited to go, as they are usually completely showered with gifts and attention there. I was really ready to build a nest to birth in, and was ready to focus on that, so I was thankful the boys had somewhere good to go.

I set myself up in the baby/Erick’s room with my birth ball and Hypnobabies. I found that during contractions, it felt good to lean back and recline- less pressure on my cervix, I guess. I was moaning through them, yet they were still only about 30 seconds or less in length, and probably 10 minutes or so apart.

Rick came home and cleaned the house and brought me water and anything else I needed. Lindsay got to our house around 8:30. I was so happy to see her! Early on I had a contraction and began to moan, and she started to co-chant with me, and I started cracking up and then so did she. She said, “well, I thought you weren’t going with it, I was trying to help.” (co-chanting was a big part of John Ross’ birth)

This laughter, this fun, is what I most wanted for this birth. I wanted to *enjoy* giving birth. To be present, and birth in awareness. I wanted to talk and laugh and bond.

I showed Lindsay some fun, new things around the house, including the bathroom with large tub that Pop was redoing for me and the birth. We then went downstairs and watched a movie that I recorded called “Shag.” It is a movie that she and I both loved when we were young, and it was so fun to watch it together. We knew a lot of the cheesy lines and were cracking up at how silly the movie seemed now, while remembering how “cool” it seemed to us in our youth. During the two hours of the movie, I’d have contractions, go to the bathroom, and ate some graham crackers with peanut butter. Pop watched the movie with us, and basically just waited on me hand and foot.

After the movie, we decided to go for a walk, to see if that would help things progress. It wasn’t comfortable to walk, and I felt rather vulnerable out in the day light with neighbors driving by. With every contraction I felt the need to pee so badly. We just walked a little ways, very, very slowly, and then came back home. I laid down on the couch and actually fell asleep between contractions.

When I woke up, I felt kinda embarrassed or guilty for things not progressing faster. Here I was with Lindsay off work, Alexa’s kids in childcare while she waits for me to tell her it’s time to come over, and Rick off work and “ready.” I voiced my feelings and got reassurance from Lindsay, and especially Rick. I called Alexa and asked her if she thought I should be actively trying to get things to progress (walks, nipple stimulation, etc), or if I should just rest and hang out. She recommended I just go with the flow, and enjoy the day. To balance activity with rest. So, with that, I said, let’s go to lunch!

Lindsay, Rick, and I went to eat lunch at Panera. I was actually really hungry and ate the entire meal. I was having strong contractions, although by being out in public, I realized that I didn’t have to moan through them. I would just look out the window, or put my face in my hands and breathe. If someone were to watch me, I’m sure they would have known I was in labor. The contractions remained about the same in length and intervals.

After lunch, I didn’t want to just go home and be bored; I wanted to have fun on this day with my sister and my husband! I said, let’s go see a movie! We went to the theater and picked a light comedy, “”Extract.” Walking into the theater was slow, with small steps. Basically, whenever I changed positions (from sitting to walking) I’d have a contraction in addition to the regular ones I was having. We went to the bathroom a few times while we were there. So much pressure! There were a few other people in the theater, so during the contractions, I’d lean forward in my chair and just breath in and out slowly and audibly. I’m not sure what those people thought if they could hear me! Then, I’d go back to watching the movie. The contractions were getting stronger, it seemed. After the movie, we slowly walked to the car, and I kept my eyes on the ground the whole time, so as not to make eye contact with any passerby.

When we got home, I got into the bath. Oh, how nice it felt to be in the warm water in the big bath my husband made just for me, for this day. My hands could relax and float at the surface of the water. Limp and loose. I listened to my hypnobabies CD. I could pee with every contraction without having to get up and move! Heaven. Rick ran to the store to get me different headphones because the ones I had kept falling out. Lindsay laid on the bed checking email. It felt very relaxed and safe and simple.

I didn’t know when I wanted Alexa to join us. I didn’t feel like I “needed” her per se, and I was worried that another person joining the little nest we’d created would throw off the balance. She called Lindsay to check in on us, and I had a contraction during their conversation. She heard me chanting/moaning and told Lindsay that it sounded like I was in laborland and she’d like to come on over. I agreed, although it still seemed early to me.

She got to our house around 6:00, which turned out to be perfect timing. I was still in the bath. The water had become cool, but it still felt so good to be in there. Alexa and Lindsay sat in the bathroom with me, chit chatting quietly between contractions. Rick went to shower and shave and change into the soft blue shirt I had chosen for him to wear. I started to feel nauseous, so Alexa gave me a washcloth with peppermint oil on it to sniff. I held that cloth up to my face and just breathed…breathed. After awhile, I decided it was time to get out of the tub and change things up a bit. Oh, it was hard to get out of that water! Lindsay and Rick dried me off from head to toe, stopping while I contracted. Getting underwear and clothes back on me was so exhausting, as they stuck to my huge, awkward, damp body. Finally I was dressed. The plan was to go sit on the birth ball again, but I didn’t make it that far.

I stopped in the hall bathroom to sit on the toilet and I realized that it was starting to feel very intense. I could barely move without another contraction coming on. I told Alexa that I wanted to save some energy for the walk from the car to the hospital, and questioned whether she thought we should go or not. About that time, the contractions seemed to be coming one after the other, and calmly she said that she thought I seemed ready to go.

Rick began loading the car with the bags I’d packed, the quilt my best friend Amy had made for me, my ball, my sign, my birth plan…

Getting down the stairs was no easy task. I went so slowly, with the support of Lindsay and Alexa. I stopped every 2 or 3 stairs for another contraction. Finally at the bottom, I looked around the living room in what felt like slow motion for any last minute items, and spied my water on the fire place hearth. I walked over to get it and put my hands up on the mantle for a real hard contraction. Alexa came behind me and rubbed my back. When it was over, I went out to the car.

It felt surreal to be outside. Strange that it was daylight and the world was going about as usual. I felt a million miles away from everything outside of my people and my contractions. I tried to sit in the front seat and it was like a torture chair! I immediately got out to finish my contraction- there was no way I could sit in that chair! Alexa, thankfully, recommended I sit in the back seat on my knees, leaned over the back. So, that is what I did, with the support of Lindsay in the backseat with me. Rick drove us slowly and smoothly to the hospital, while Alexa followed behind in her car, calling the midwife Toni, to tell her we were on our way. I felt so much pressure during each contraction. It is likely that this was transition, based on when Della was born. I felt nauseous, and couldn’t hold it back any longer. Thankfully, we had remembered to bring a bowl, which Lindsay held lovingly for me, eventually passing it off to Rick where he dumped it out the window at a red light. What must the other cars have thought?!? Rick drove as slowly and smoothly as he could, and still it felt like I was trying to survive the car ride. Contractions would come so forcefully, pushing all Della and my energy down down down, and then my body would be bouncing and turning with the car. My feet fell asleep. I tried to wiggle them awake, but eventually had to change positions and lie on my side to allow the blood to flow. I was exhausted.

We pulled into the hot parking garage at 7:30 and everyone got out. I just sat there- completely drained and on a different spiritual plane. Looking back, it is like I was in a dream. Alexa asked me how I was, and I just stared at her, finally saying “tired.” Rick got all the bags out of the car, and I wrapped one arm around Alexa and the other around Lindsay. We walked slooowly through the parking garage. I kept my eyes closed and my hypnobabies turned up loud so as not to have to have any interaction with or knowledge of other people in the garage. It was so hot. I felt sweaty and clammy. I vomited three times as well walked from the car into the hospital. Oh, that air conditioning felt amazing as we walked in through the automatic doors! We turned to get on the elevator and I noticed a man behind us. Like an animal in her cave, I did not want an outsider to enter. I told Rick, and he asked the man to wait for the next elevator.

We got up to the third floor and Rick checked me in. While I waited, I was aware of other people in the waiting area, but I closed my eyes and acted as if they weren’t there. A registration worker approached me at one point just as a contraction was beginning, and Lindsay kindly said “wait just a minute” and then she moaned in perfect harmony with me so that I would not feel awkward. It felt so good to know that she was supporting me and “had my back.” I felt safe.

We were given a room number and continued on to find it. As soon as we got into the room, I went straight to the bathroom and sat on the toilet. It felt good to sit and to pee. Rick gave the nurse a copy of our birth plan and answered any questions she had. Toni, the midwife, came in to see me. She asked me how I was and told me that she wanted to put me on the monitor to listen to the baby. I asked if I had to move, and she said that yes, I’d need to go to the bed. Well, that wasn’t happening, and Lindsay intuitively knew it. She asked Toni if there was a way we could do it in the bathroom, that she would hold the monitor in place. Toni said okay, and shortly after a tiny little box the size of a pack of gum was in Lindsay’s hand, listening to the baby. Toni had also said that she wanted to check my cervix for dilation, but again, not happening.

I had a few contractions on the toilet, and then Alexa told me that it was normal, but that the baby’s heart rate was starting to drop a little, and she wanted me to change positions. She knew that this is often a sign of the baby descending lower preparing for birth, but just to be sure, she recommended I get up. I’d do anything for my baby, of course, so I stood up, took two steps toward the door, and then dropped to my hands and knees for a contraction, still in the bathroom. Lindsay and Alexa reassured me that it was okay. I felt a lot of pressure in my bottom, and decided to just go with it. I started to push (between 8:40 and 8:45). I realized I was pushing, but I really wasn’t sure at first if I was going to have a huge bowel movement or a baby! It became obvious to Lindsay and Alexa that I was pushing, and through frantic whispers they alerted the nurse to find Toni. I still had my pants and underwear on. I occurred to me that if I pushed the baby out into my pants that would probably not be good, but I couldn’t stop pushing and I couldn’t focus on getting my pants off. During a push, my water broke (8:43 pm) with a pop and a gush. I calmly said “my water broke” and kept pushing. My waters got on Lindsay and myself. Alexa told the nurse and Toni, and they wiped some up with a towel to check color (the lights were off in the bathroom). Toni said there was a little bit of meconium. I started to feel my baby’s head in my birth canal, and then soon through the parting lips of my vagina. I was basically sitting on my knees, so Toni told me that I needed to lie on my side. She told me a few times, and so I did. Lindsay held my weight under my arms, and I laid across her body. Rick went to wash his hands and then joined Toni in front of me so he could catch the baby. I put my hand between my legs and felt the baby’s head stretching my perineum. It stinged and I tried to put counter pressure against the head so as to slow down its exit, hoping to allow my skin enough time to stretch. Toni had some lubrication gel and kept asking me to move my hand so she could apply it, but I felt very protective and didn’t want anyone touching me for fear that it would cause more pain. Lindsay kept telling her just to do it around my fingers, and I think she finally did and I moved my fingers a bit.

And then into my hand the head was born. It really didn’t hurt that bad. It’s so surreal when just the head is out, but the body is still in. The baby is here, but not quite. They don’t cry yet. It’s like time just stops. I remember the baby’s head felt so small in my hand. So wet. Toni used a stern voice to tell me to move my hand. The umbilical cord was wrapped around the baby’s neck 3 times. She unwrapped it, and I pushed again and out came the rest of the baby. The cord was also wrapped once around the baby’s body.

I don’t know if it was something I actually saw, or because of how dark it was, or if I was just in a dream and saw what I expected to see, but I thought I saw a pinky sized penis. I said “it’s a boy!” No one thought to question me, and the baby was all curled up so it wasn’t easy to see. The baby wasn’t crying (apgar of 5, then 9), so Toni was rubbing and trying to stimulate the baby. Lindsay said “talk to your baby,” and so I did. I talked to Seth. I called him by name and professed my love and pleaded to Toni to make him okay. Toni handed Rick the scissors to cut the cord, and Rick reminded her that we wanted to let the cord stop pulsating before we cut it. Toni said that the baby needed oxygen (which would be administered in the actual room, not on the bathroom floor with me), so the cord needed to be cut. Looking back, I don’t think the baby really needed oxygen; I think it was personality not to cry.

Toni and the nurses took the baby into the birthing room, and I told Rick to go with the baby. I remember feeling great and amazed that it was already over. I looked out at the nurses and saw one of them say something with a confused expression, and then immediately I heard Rick shouting with the most joyful voice, “IT’S DELLA RUTH! IT’S DELLA RUTH! HONEY, IT’S DELLA RUTH!” Lindsay said “it’s a girl, that’s your daughter!” and I just started wailing with tears and emotion. I will never, ever forget that moment. The cry was of thanksgiving from deep within my heart and soul. I had a daughter. Della Ruth. It was so unreal.

I love that there was a time when we thought it was our third son, to have been named Seth Leon. In that moment, I loved my child- boy or girl- didn’t matter. It was the unconditional love of a mother. But to find out that it was my daughter, just felt like an answered prayer because I think deep within I knew it was Della that was supposed to be born.

I was helped to the bed in that big, beautiful birthing room. Outside it was dark and I could see cars driving by down below. I was handed the beautiful, blanketed Della and fell deeply, heavily in love. Rick said, “honey, we have a daughter” and he started to cry. She looked right in my eyes. Oh, she was beautiful! I kept remarking on how tiny she was compared to her brothers. All her little features were perfect. Her little ears, nose, mouth…breathtaking. I took off my top and bra and put her to the breast. With her eyes locked on mine, she began licking my nipple. It was the sweetest thing ever! Like a little kitten she licked and sniffed my nipple, finally latching on and sucking perfectly. Dear God, how thankful and happy I was!

Della Ruth Digby sprang from my heart to my arms- 9/11/09. 8:54 pm. 7 pounds, 8 ounces. 21 inches.

Birth Story of Noah told by his mom

My version of Noah's birth story
-by Lindsay



Noah's due date was August 20th, 2009. Throughout my pregnancy I kept thinking/hoping he'd be late so I could attend my brother, Mark's, wedding on August 22nd. Maybe all my pep talks worked because he stayed put! Then, on Monday August 24th I went to my final prenatal appointment. My midwife, Margaret, said I was about 1-2 cm dilated and 80% effaced. She could feel my belly contracting and thought I might be in early labor. They did a non stress test to check out Noah's heart beat and track my contractions. It went just fine. I left the office thinking I'd probably be back for another appointment the following week.

That night I decided to give eggplant parmesan a try. Figured it couldn't hurt and I thought it'd be funny if I did go into labor afterward. Met my mom at Provino's and we had a great time. Around 9:30 Brian and I decided to go for a walk. Before we left I used the bathroom and realized I had begun to lose my mucus plug!! I continued to lose more throughout the day on Tuesday. That night we went to bed around 10:00 and I woke up at midnight to pee. Then again at 1:00. Except that time there was more than just pee! My water broke! It started off mostly as a trickle so I decided to go downstairs, check my email, and wait to see what happened. It definitely picked up and contractions began.

I called Margaret to let her know what was going on and she told me to try to get some more sleep. Laid down for a while but couldn't get comfortable enough to fall asleep. Went back downstairs and started timing contractions. They were about every three minutes. Contractions continued to get worse so I woke up Brian. Called our doula, Teresa, at 4:00 and told her what was happening. Finally at 5:00 the contractions were strong enough that I wanted to leave for the hospital so we wouldn't get stuck in rush hour traffic. Our drive only took about 30 minutes but that was a very uncomfortable car ride! Tried to distract myself by singing along to 80s songs in between contractions.

When we got to the hospital the elevator took forever. I remember holding onto the wall, breathing through contractions while waiting to go up to L&D. Once there, Brian signed us in and we were taken to a triage room. Our nurse, Jennifer, asked me to put on the hospital gown and I told her no, I was going to wear my own clothes :-) Teresa arrived a few minutes later and the nurse hooked me up to the machine to monitor baby's heart beat and my contractions. She also checked my cervix and announced I was 6-7 cm dilated! That shocked me. We stayed in triage for at least an hour or two. Teresa was pushing for them to get me into a room with a tub since I was so far dilated. Poor Brian started feeling really sick to his stomach and threw up right before we left triage.

We were eventually moved to a delivery room (with great views of Atlanta) and Margaret showed up while our new nurse, Rebecca, strapped more monitors onto my belly. I sat in bed while she took all the readings and Margaret got the tub ready. After they were done monitoring me I got out of bed and leaned over the window sill while Teresa massaged my back. I was having a lot of back labor. That was no fun! A little while later Teresa said "you could get in the tub, you know..." so I did just that. It was great. The warmth and buoyancy of the water made the contractions easier to deal with. Brian was so exhausted...they instructed him to lay down in the bed and take a nap. Good thing we had a doula :-) Eventually he got up and started helping me with back labor. He pressed so hard on my back for so long he was sore for a few days afterward! Margaret checked my cervix and found I was about 5 cm dilated. She thought the first nurse was probably wrong when she said 6-7 cm.I stayed in the tub for about three hours until Margaret suggested I get out and walk the halls.

Walking made the pain worse. I had to stop every other minute to hang onto the wall railing and moan. Brian would press on my back which helped me cope. After just a few laps I decided I was done with the walking and headed back to our room. Next I tried sitting on my birthing ball and again Brian pressed on my back. I was starting to breathe in an unproductive way and Teresa got me back on track. Saying "OHHHHHH" in a really deep voice helped. Eventually I got back into the tub.

The back labor continued so they had me do an exaggerated sims position to try to rotate the baby. So uncomfortable! Margaret checked me again a couple hours later and found I was 8 cm dilated and 100% effaced. Shortly after that I felt like I wanted to push. Teresa told me to do little grunts during contractions to help with all the pressure. I continued to want to push for the next four hours. At 3:00 I was 9 cm and I didn't reach 10 cm until 7:00! I was so happy when they told me I could begin to really push.

The pressure was overwhelming. Seriously felt like I was going to poop out a 15 lb bowling ball. I pushed while squatting, on my knees, sitting, lying back, holding onto a sheet tied to the bed, etc. It was frustrating because I felt like I wasn't making any progress...seemed like he'd go all the way back up after each push. At this point it was dark outside and a storm was rolling in. I had three midwives, a nurse, Teresa, and Brian cheering me on which was really neat. They kept telling me to push harder but I didn't know how. My energy level was so low after being in labor all day.

I ended up pushing harder than I ever could have imagined and finally his head came out. They asked for one more big push and out came his body. That was such a strange feeling. His body was nothing compared to the head! The cord was wrapped loosely around his neck once which was no big deal. He was so calm and quiet when he first came out. Margaret suctioned his nose and mouth, rubbed his back, and tried to keep him warm by putting towels over him in the water. Finally he let out a cry and my mom came running in saying "I can't take it anymore!!" It was 9:50 pm and she had been in the waiting room since 8:30 am!

Brian cut the cord and started crying. I was too tired and relieved to cry. I think my reaction was more like "WHEW." I got to hold him while we were both still in the water which was awesome. He was so cute. Margaret took him away a few minutes later so they could warm him up. His APGARs were 8/9, he weighed 9 lbs 2 oz, and he was 20.5 inches long. I got out of the tub shortly after giving birth and got in the bed so I could deliver the placenta (what a WEIRD feeling!) and Margaret could repair my 2nd degree tear. Ouch. Teresa helped me focus on something else while that was going on and also helped me start breastfeeding. My dad and in laws came into the room to check out their first grandson. After that we headed downstairs to our postpartum room. Noah came with us instead of going to the nursery which I was very happy about. We settled in for a two night stay and fell in love with our precious baby boy.

Parts of the Puzzle that Make for a Good Outcome

Recently a local childbirth educator made a comment that students in her classes had the average cesarean rate of consistently 10-12%. I thought wow that is great- I have never kept statistics on my students. I have kept statistics on my doula clients- over the last year my primary cesarean rate has been 8% and all of the cesareans- not including planned ones for things like placenta previa- but including women who had previous cesareans had only been 12%. But it made me think of all of the pieces of that go into the puzzle that makes for a "good" outcome. I realize "good" is a subjective word- so for the sake of this blog article, I will classify "good" as non interventive or at least having only the interventions you as a consumer choose.

Often times a couple who chooses our classes- certainly different than the "normal" hospital "how to be a good patient" classes. So they are usually looking for a different approach- perhaps in an attempt to have "their" birth experience- not the hospitals or their care providers. They are usually open to hearing new ideas that will help expand the ideas they are already developing on their own.

Often times a couple who chooses our classes are not choosing the "normal" birth experience and therefore has either chosen a care provider who is open to stepping outside of the "norm" or soon figure out from the class and their own exploration that the provider they have chosen will need to either get on board or they will need to find a new one.

Often times a couple who chooses our classes are not reading "What to Expect When You are Expecting," or "The Girlfriends Guide to Pregnancy and Birth." They are reading books like "Birthing From Within" and "Ina May's Guide to Childbirth." They are refusing to believe the view that you follow protocol even when it is not what you want.

Often times a couple who chooses our classes are considering their support team carefully. They either surround themselves with family and friends who are on the same page- or they choose to hire a doula. The added support of a doula is definitely documented in numerous studies to make a real positive difference in birth outcomes.

So I choose to believe that my classes- our classes at Labor of Love offer one more piece of the exploration process for a couple to consider in their journey to parenting. My mom used to tell me if you take credit for all of your kids positive characteristics, you must also take credit for the bad ones. I choose to be happy about the characters of my children- and will praise them- hoping that I did influence them but fall just short of claiming credit!

My advice is to prepare for your birth as much as you prepared for other important, life changing experiences in your life up to this point. Choose your care provider carefully. Choose your support team carefully. Choose how you educate yourself carefully. Blend all of this together and you will likely have a "good" birth experience and one where you can take full credit for the choices you made along the way.

Lamaze Six Healthy Birth Practices

Lamaze has done a great job with this ...


Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible.

Check out this page for some great video clips and even some printable material!

This is definitely worth your time to check this out!

The hardest part of being a doula- part 2

I have written before about being on call being a difficult issue for doulas. Many times I get a call from someone wanting to be a doula. But besides the erratic schedules, the need for excellent childcare and a supportive partner- it is essential they understand the idea of being on call. We are on call "officially" for the due month- which is 38 weeks to 42 weeks- but of course if a mom goes prematurely we make sure she has a doula, even if her primary is not available. But there was a conversation today that I wanted to share with you.

When you are a doula, you may be hire months in advance of the woman's due month. We have folks who hire us as early as 12 weeks- we will not accept a retainer prior to this time. But things come up sometimes unexpectedly. I am not talking about illness or family emergencies- I mean things like a friend's wedding, a special concert, a last moment opportunity for a vacation, etc. But in Labor of Love's business workings- we ask that when you are hired by a couple, you are fully available during her due month- meaning those things you want to do that arise are back burnered to the mom in labor. The exception to this is of course if when you are hired- you enlighten a couple to a possible date conflict within their due month and they hire you irregardless- knowing you will have a back up in place when that special event occurs.

Well we discussed as a group today the idea of a couple hiring the group- not a specific doula. We came by this idea based on two things. First since this is a difficult if not the most difficult part of doula work it would make our lives so much easier if we knew specific days we would be on call and days we could be free to do other things without worry about not being there for a mom. Second,we get couples all the time who attend the Meet the Doula Tea and say they would be be happy with any of us.

But as we discussed the logistics of offering this as a potential service at a lower rate than the average doula in our group, we realized it benefited us as doulas but was not in the best interest of the couples. Already moms often have no idea who will be the care provider on call when they go into labor. In fact there are several groups who now share call with other groups- meaning you will not have ever even met the doctor who shows up to catch your baby- he or she has never read your birth plan- has no idea what your birth ideals are- and really is not that concerned about it. Their job is to show up and catch your baby and make medical decisions for you but is not invested in your birth experience outside of that.

Often times a woman will even entertain the idea of induction with all of those risks in order to get her preferred doctor. Although that is not guaranteed either since often inductions go longer than expected and the shift change of on call changes too. The last thing we would want is someone to consider an induction to get their favorite doula who would be on call. The risk of induction is somehow out weighed by the familiarity of desire for those who will attend her. This is awful.

Continuity of care is something we offer. We will stay with you during the duration of your labor- no matter how long. I talked with a doula with another group in town recently who has small children- she said she would not be able to attend a mom irregardless of the length of her labor... she said she would call another "fresh" doula in place. We may call in help to allow us a power nap with the mom still fully supported- at no additional cost to the mom- if her labor went unusually long- but that is rare. We have found we make 97% of our births- the other 3% are covered during those rare occasions when an emergency arises for the primary doula- by a back up doula. The fantastic thing about our company is we have several wonderful doulas who folks get to have met at the teas we do bimonthly.

Penny Simkin was quoted in a publication the IHS Provider page 155 "Doulas “hold women” by supporting them emotionally during their pregnancy, labor, and birth. The doula meets with her expectant mother one or more times before the birth and discusses the mother’s expectations or ideas of what the birth will be like, and issues of importance, such as pain medication preferences or infant feeding choices. During these meetings the doula supplements information the mother has learned in prenatal classes and explores misinformation she may have gleaned from what she has heard or read. The doula empowers the client to eat well, observe healthy lifestyle practices, and exercise, all to prepare for a healthy and positive birth experience. A doula may use this time to enhance communication within the woman’s support network, including family and partner, and/or may give advice about how to communicate effectively with the medical staff.

During early labor, the doula and her birthing partner stay in close contact until the mother needs additional support, at which time the doula will join her, meeting the mother at her birth place. She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period. She will talk about normal contractions with the mother and will provide an objective viewpoint. Knowledge of what is normal replaces fear of the unknown. The doula listens to the mother and responds to her needs. The presence of the doula, who is calm and committed to the mother’s well-being, counteracts the effects of elevated stress hormones (adrenaline and noradrenaline), which are released when the mother becomes anxious, fearful, or insecure. A trusting, relaxed mother is able to continue producing oxytocin, which then keeps the labor in its normal rhythm, with the perception of pain diminished greatly. Most importantly, the doula lessens the anxiety of the laboring woman with quiet reassurance and enhancement of the unique talents and strengths the laboring mother brings to the birth."

And at Labor of Love we agree."She will then stay throughout the entire labor and birth and for up to two hours during the postpartum period."

That relationship, "supporting them emotionally during their pregnancy, labor, and birth." is essential and one we are not willing to compromise by having a varying and rotation of doulas on call for the mom. We love having a well established relationship built prior to the labor and birth. We love the phone calls, the personal talks, the emails along the journey.

So, although it would make our lives easier- we realized it would not be easier for the moms themselves. We want to be the consistent,non variable support to couples in their labor and birth. We want them to know we will do our very best to be with them- the doula they selected as their primary- and insure that is our goal. If it makes our life a bit more difficult, then so be it- we love the work we do. For us it is our calling. We love being with women in birth. We feel blessed to do it. Our families are understanding although it is difficult for them at times. But if they love us and they understand our work is in our hearts and gives us that which we need- they support us none the less.

So, know where our hearts are- with you... for you... in support of you.