poems for labor

In the midst of the chaos
When the wind is howling I hear
the ancient song
Of the ones who went before
And know that peace will come
-Susan Stauter

May the sun bring you new energy by day,
May the moon softly restore you by night,
May the rain wash away your worries,
May the breeze blow new strength into your being,
May you walk gently through the world and know its beauty all the days of your life. –Apache blessing

For as long as it lasts let the singer be the song.
For as much as it’s worth let the truth outweigh the lies.
For this single moment in time let my own voice be heard.
–Susan Stauter

“Come to the edge,” he said.
They said, “We are afraid.”
“Come to the edge,” he said.
They came.
He pushed them and they flew.
-Apollinaire

What lies behind us and what lies
before us are tiny matters
compared to what lies within us.
-Ralph Waldo Emerson

I know nothing with any certainty, but the sight of the stars makes me dream. –Vincent Van Gogh

What Makes Women Warriors?

According to Wikipedia "A warrior is a person experienced in or capable of engaging in combat or warfare, especially within the context of a tribal or clan-based society that recognizes a separate warrior class. According to the Random House Dictionary, the term warrior has two meanings. The first literal use refers to "a man engaged or experienced in warfare." The second figurative use refers to "a person who shows or has shown great vigor, courage, or aggressiveness, as in politics or athletics."

So I want to consider when a woman is in labor- how does she become a warrior? I love the phrase "warrior woman." I feel the way we carry ourselves through our journeys of adversity we become warriors. But for the sake of this blog, I want to explore the aspect of labor and birth.

A woman who shows "great vigor, courage or aggressiveness" in labor and birth... hmmm. Does a woman have to birth naturally- without any pain medication to be a warrior? Nope, I don't think so. Is she more of a warrior if she goes natural while being induced with labor augmenting drugs? Perhaps she may think so, but nope I don't think it is a competition. But women make it a competitive arena. Just share with another woman that your intention is to try to go without pain medication and she will tell you how ridiculous that is- making you feel like it is an insurmountable feat to try to do so. But find a woman who did give birth without medication and she will tell you that you do get a prize for doing so... and she will explain how easy her recovery was, how well breastfeeding went, etc. But this is not always true.

We had a client who took our classes and hired a doula and planned an pain medication free birth. But due to some past issues, her labor as it unfolded brought up a lot of stuff she thought she had dealt with, but had not. Her labor was hard and unmanageable and she chose to get an epidural. Was she a warrior? By all means she was! With her second birth, she planned on getting an epidural in her labor and did so. She had a great second birth. Was she less of a warrior? Nope, I don't think so... She figured out what she needed and worked through that which she could, and chose the labor that was right for her.

My daughter chose a homebirth with her son. When people heard she was doing so, they commented on how brave she was. She then would ask where they were giving birth and when they named their hospital, she would tell them no they were brave! She did not feel comfortable giving birth in the medicalized birth arena. Was she more of a warrior? I feel her battle would have been more difficult if she had gone to a hospital. She was a warrior in her labor the same as the first mom.

I have written about doing the next best thing- when your options or choices change in your labor- it is about being flexible as things arise. But being a warrior to me is more about not allowing yourself to be bamboozled and manipulated. It is about asking questions and then finding the answers that are right for you.

I received a call recently from a woman who was seeking doula support for a hospital birth where her care providers were midwives. But in their prescribed birth plan- the only one you are allowed to have- where you check items... it stated that you should only choose natural birth if you could control yourself. Hmmm... what does that mean? I do not think a woman in labor needs to act in some prescribed way that is considered in control by those who are supporting her. She should feel free to move and make sounds that help her in her labor. This group also stated that they would be the ones who decided when you may need labor augmentation and they would decide how it is administered. Wow- so does the woman give up her autonomy in her decision making about her body and her birth? When did informed consent get thrown out of the door? This same practice does not "allow" a mom to go past her 41st week of pregnancy although the ACOG says that she is not past due until her 42nd week.

I do appreciate that this information is handed out early in your pregnancy so you can decide if this is the way you want your labor managed.

Warriors- what should our battles be? We do not need to fight with care providers when we are in labor. We need to battle our fears ahead of time- not in labor. We need to fight fatigue and do the work of labor , and those around us need to be on our team- our comrades in the battle!

I love the scripture in Exodus 17 "Moses' arms soon became so tired he could no longer hold them up. So Aaron and Hur found a stone for him to sit on. Then they stood on each side of Moses, holding up his hands. So his hands held steady until sunset." As a doula, as a friend, as the care provider, as the nurse...this is our role with a woman in labor.. to hold up her hands so she will be supported even when tired...

I love this quote by Laura Stavoe Harm,"There is a secret in our culture- it is not that birth is painful, it is that women are strong." We need to find that vigor and courage that we are made to have in labor. Being courageous is what makes us warriors. Having the courage to keep looking if the place and provider is not the right one for us; having the vigor to drive farther away to get those if they are not in our neighborhood. We need to have the courage to look within ourselves and determine the path we want to follow. But part of that determination must be with informed consent.

And we need to take ownership of our decisions.For instance you can not decide to get an epidural and then complain about the side effects you may have from them- as if someone made you get that epidural. You can not stay with your care provider and then in labor when they are not supportive complain that they are not on your team.

Warriors are made by battling through adversity- finding the truth for yourself- and having courage to move forward. It is not about a prescribed way to give birth- it is about making it your own!

It is in a relationship...

Relationships take time to develop. When you pick a doula it is best to hire her as soon as you can so you can develop a relationship with her. She needs to be someone you feel you can be honest with and share your inner most thoughts regarding your birth fears and ideals. It needs to be someone you can trust. This is a double road though- it is up to you to make this happen as well as the doula.

We had a client who hired a doula several months out. Although they discussed things and chatted along the way, some things were said or shared that made her question her decision in her selection of her doula. She did not address these concerns. She did not ask for clarification or share her thoughts about what was said or misunderstood. And just like when your partner does a bunch of little things that bother you and you do not address them, the group of them together makes for a sore spot between you. This did not make for a relationship that would foster a great doula-client relationship.

We see women select care providers and find out along their journey that this care provider was not going to be supportive of their ideal birth. But instead of addressing their concerns, they either dismiss them or they decide that perhaps it won't really make a difference. But this is a relationship that will not foster a great care provider-client relationship.

Do yourself and your doula a favor... in fact do everyone in your life a favor and share with them the thoughts that make you uncomfortable when they occur. Address them so they can either be resolved or so a decision can be made early on to switch doulas if the doula is not a good fit. Sharing early on may have been something that could have allowed the relationship to grow and flourish rather than falter. After all it is about the relationship. Every match is not one made in heaven. But being honest is the best way to maintain relationships that will bring the blessings to your life and your birth!

We had a client tell their doula they did not want a particular doula to be their back up. When questioned about it, they did not feel she would be a good fit since her personality when they met seemed different than what they felt they may need in their labor. We have enough back up options that we certainly are able to accommodate that request. But keep in mind, just as Paul states in the bible that he became all things to all people to win as many as possible, a doula can become what you need. For instance I have had clients want me to be gregarious and fun in their labors. I have had some ask for almost complete silence in their labors. I have had some who loved the casual conversations in the background that insured them all was normal. Doulas become what you need in your labor. But you need to let them know what you need. Since every woman has her own particular needs, your doula needs to know what you think you will need. But ironically that may change when you are actually in labor. She knows how to be flexible as your needs change.

A doula who is gregarious and funny at the Meet the Doula Tea may be the quiet, calm spirit who holds the sacred space of labor and birth for you. So, remember just as you may have a different personality at a party than at your labor, so she may as well. Ask questions that will enlighten you to her full personality before deciding she may not be who you are looking for to support you.

I often tell women not to lie to their care provider- don't expect them to be truthful if you are not willing to be truthful to them. I feel if you can't be vulnerable and honest with them, your relationship is not one of trust for your labor and birth. This is certainly true for your doula as well. Be honest, be vulnerable, be open- it will help your relationship become what will be most beneficial to you for your birth experience. Understand that misunderstandings occur, but share your feelings if they do so it can be cleared up. Communication is paramount for growth in this relationship.

I spoke to a friend who is a bit older than me. I said the bad thing and the good thing about getting older is you don't care what people think of you. But the truth is you should always care how others feel from your actions or words. But again, sharing how one makes you feel will help resolve any negative feelings you may have from someone else's actions. She said that sometimes when we get older we know things, we feel we need to speak the truth- even bluntly- and that those who are not in the same place are unwilling to hear the truth. I think about the phrase, "folks don't care how much you know, they need to know how much you care."

Sometimes I think in an effort to share what we know from our experience, we have our comments come across too emphatic and opinionated. I used to think that if you did not fully believe something, then you could not really have a strong opinion worth sharing. Now with age I realize everything is not so black and white. Fully supporting women sometimes means not sharing your opinion unless they really ask for it. As a doula that is often hard to not feel the need to share what you feel is truth that will protect them. But sometimes too much information can overwhelm a mom. It is a fine line in this relationship. We begin to feel responsible for them instead of to them.

Polly Perez a friend of mine- and an internationally known birth advocate shared this with me recently. "

I had to remind myself the difference between feeling responsible TO or FOR many times....
That is why I wrote the following handout and even put it in one of my books hoping it might be helpful to others.
Hope this will help your in some way in your current situation....

Here is the handout---
The Difference in Feeling Responsible TO and FOR

When you feel responsible TO others....
You show empathy, encourage, share, confront, level, are sensitive, listen.
You feel relaxed, free, aware, high self-esteem.
You are concerned with relating person to person, feelings, and the person.
You are helper/guide.
You expect the person to be responsible for themselves and their actions.
You trust and let go.

When you feel responsible FOR others....
You fix, rescue, control, carry their feelings, don’t listen.
You feel tired, anxious, fearful, liable.
You are concerned with the solution, answers, circumstances, being right, details.
You are a manipulator.You expect the person to live up to your expectations.

So, find a care provider and a doula who will feel responsible to you. And be responsible yourself and share your feelings- after all it is about developing a relationship. Be open and honest. Let her know what you think is important and will need. And then know you will be fully supported in your labor and birth!

Semantics....

Recently in a prenatal meeting I posed a number of phrases to get the couple's thoughts- it helps me to understand what is important to them. There was one "I gave birth, I was not delivered," that I posed to them. Usually it is met with how they feel giving birth is something they do- vs. being delivered is something that is done to them. But this mom did not share until much later what she felt about that phrase. She said, "I actually prefer the word "deliver" because it's more empowering to me; "birth" seems too passive, as if you're a bystander."

This response made me realize that different things provoke different feelings in folks. I have to say this was the very first time in years of using these phrases to promote understanding and dialogue, that a woman shared this thought. I realized that if she felt "deliver" had more power, than by all means I wanted to use the word "delivered" when talking to her about her experience.

But this made me realize that if words are powerful, who gives them the power? Individuals do! It is important to allow a woman to use the words that help her have more power. For instance the hypnobabies program have words they use... deliver is replaced with giving birth, the husband is the birth partner, contractions are pressure waves or sensations, labor is birthing time, pain is discomfort, labor room is birth room, transition is transformation, false labor is pre-birth waves, pushing is ahhhh pushing or breathing your baby out and due dates is guess dates. They want to replace all negative connotations to be positive words.

But wait- who makes words positive or negative? Shouldn't the mom be able to decide what works for her and what does not? I personally like the word birth more than deliver- but it is not my birth- or not my delivery- it is hers.

Hypnobirthing has their own words to use- some that are considered no nos that promote fear instead of correcting the years of negative subconscious belief. Well again- what if our subconscious belief has been full of positive birth beliefs? And what if we are not afraid of words like powerful contractions or labor is hard work- or labor hurts but I can do this? Shouldn't I be able to use those words or phrases?

I think women should use the words they want to use. I hate that my phrases that were to promote thought and discussion made this mom feel I was coercing her to believe my words... nope - I wanted it to help her discover what she felt. And it did. Words are only given power by the one using the words or finding the word has power for them. Please share the words you need with those who are there to meet your needs!

My youngest daughter uses words I am not comfortable with sometimes and when I say so to her- she reminds me that we give the power to the words- that words themselves have no power. So, if you want to have specific words used or not used in your labor- then tell those around you what words work and what words you want to have avoided. If you are surrounding yourself with folks to help you achieve the experience you want, help them to help you by sharing the words you desire to hear as well.

But, I think it is unrealistic to expect everyone in a hospital atmosphere to not use their "normal" phrases. At a home birth it may be easier to accomplish this. I think making some birth art or encouragement cards with the phrases would be a great reminder for those around you. I have tried in my years as a doula to help change some semantics by hospital staff thinking I was helping women. For instance I do not like referring to a mom as the cesarean section but instead she is the mom who had a cesarean birth... But much to my surprise, I was taught by some wonderful women in ICAN that they did not like the term cesarean birth- because they felt it softened the surgical experience that they so wanted to avoid in their future.

There are several other phrases- like the word circumcision vs genital mutilation- hmmm you know how one feels based on using that second phrase don't you? But some words hold less impact on their use- for instance I love the baby who is breastfeeding called a nursling- the mom nurses her baby- because I feel it is much more than just feeding a baby at the breasts. Lactivist call formula artificial breast milk. When a woman says the contraction she just had was a bad one, I do try to get her to use the word powerful instead because I think it helps her to re-identify it in a more positive way. I am not sure I will ever get women to embrace the word rush or surge for contractions... even though I do think labor can be a series of rushes and rhythmic surges... but some moms don't relate to those words. And who am I to try to make her use my words?

So, rather than forcing a woman to use words that she does not relate to or words that for her have no power- words that she has a hard time embracing- let's let women decide for themselves what they want to call their experiences... when we force them to embrace our words we dis-empower them by doing so. So, explore new phrases- ask yourself how the words make you feel- then share the ones that work for you with those who are there to help you!

Libby's Birth Story

This story was shared by the father- his view of how things unfolded... quite a surprise ending to be sure!

Jen and I went to bed about 11:15 to 11:30 on Thursday night, November 19, 2009. I had just fallen asleep when Jen says "Jim?" in a strong, clear voice. I said "Yes?" and woke up. Jen informs me that her water just broke. I said "Are you sure?" She informed me that she was pretty darn sure. We turned the lights on and checked the bed and there was a nice little puddle, then she stood up and we got her a towel, because she was dripping everywhere she stood or walked. She wet through two pairs of pajamas/sweat pants in about half an hour. Jen said "What should we do?" and I suggested that she call our doula and ask for advice. Jen calls and talks to her (each time Jen called someone during the birth experience it was on speaker phone so I could also hear the conversation). Our doula asks if Jen if having contractions. Jen was not having any contractions. She suggests that Jen get back in bed and rest if she can because she will have a long day on Friday laboring and pushing to birth Libby. She also suggests that we call Jen’s midwife, to ask her what she thinks that we ought to do. Jen calls her midwife and the conversation goes about like the one with our doula – "Is Jen having contractions?" – No; "Okay, then get back in bed and get some rest because you will need energy for tomorrow for labor."

Almost immediately after Jen finishes the conversation with her midwife, as she gets ready to get back in bed, she says "Oh" at the foot of the bed and puts her hands to her belly. She tells me "I think that was a “real” contraction." That was somewhere around 12:15 on Friday morning, November 20.

Jen gets in bed and tries to relax and rest. Realizing this seems to be the “real thing,” I decide that I need to finalize our preparations for the hospital. While I keep tabs on Jen I am doing little errands like washing baby clothes for Libby’s going home outfits, making sure the things Jen wanted to be in the hospital bag are in there, putting my clothes and toiletries in there, putting accessories for labor and the potential water birth in the car, and putting her wet pajamas in the dryer. During this 45 minute to one hour period Jen does not fall asleep and she has contractions that are more obvious.

I get in bed with Jen about 1am or so. I expected to help her relax and sleep, because in everyone’s mind we are in early labor and we have a long way to go. Jen is not able to relax or sleep. I snuggle up close to her in bed and hold her, hoping this will relax her and we’ll both sleep. Because I am right next to her I can tell by her breathing when she is having a contraction. Her breath was much stronger and more labored when the contractions happen. I am able to tell the rhythm of the contractions rising, peaking and dissipating. I also try to get a read on where she is in her labor. A rule of thumb that we have learned is 4-1-1. That means when the contractions are four minutes apart, are one minute in length, and are consistent for one hour it is time to go to the hospital. When I first get in bed I time the contractions in my head – they are about 20 to 30 seconds in length - and I look over at the clock on my bed table to see how far apart the contractions are – at first about 5 minutes apart, but within half an hour they are consistently 2 to 3 minutes apart, but still the same 20 to 30 seconds long. This goes on for about an hour, and her contractions are consistent at the same interval. Jen is not able to sleep at all. I probably dosed off for a couple of minutes here and there.

About 2 or 2:15 in the morning, Jen tells me that there is no way that she can relax or sleep. She says "Maybe someone else can relax or sleep, but I just can’t." So Jen gets out of bed and feels the need to walk around or to try to sit in different positions so that she can relax and rest. At one point she sits down on the toilet in our bathroom facing the water tank, with her pillow on top so that she can rest and possibly get some sleep. That lasts for about twenty minutes and then she is up walking around again. She appears to be having more intense contractions and is agitated. The thing that occurs to me now, though, is that at no time was the labor so intense or uncomfortable as to alarm me that birth was imminent. In other words, Jen is handling labor like a champ. Also somewhere in this stretch I bring Jen some wine we had in the house and she drinks about 2-3 ounces in an attempt to relax and calm down.

About 3 in the morning, Jen says that she just feels like she can’t relax and there’s no way she can rest and what should we do. We decide we need to call the doula and midwife again to figure out what they advise. Jen is pacing in the upstairs hallway during her conversation with our doula and it goes something like this – Jen apologizes for waking her up again and she, of course, says that it is no problem. Jen tells her that she can’t relax and that her contractions are consistent. She can hear that Jen’s breathing, even when she is not in contractions, is very fast. She also times a couple of Jen’s contractions during their conversation and they are 23 and 28 seconds long. She knows that sometimes in early labor contractions can be close together and can be intensified if the mother is tense, as Jen clearly is. Our doula, having just been awakened and not being able to see Jen in person, assesses that this is still early labor and that Jen needs to relax and slow the labor down. She recommends drawing a warm tub and Jen getting in it to relax. Jen also calls the midwife’s answering service and she calls back. Their conversation goes about the same.

As I write this now, almost a week later, it is much clearer to me what was actually going on. Honestly, there are times when I think about this experience now and feel like I was stupid, not protective of Jen, and a bad husband because of letting things happen as they did. It seems like any husband in their right mind would have been headed to the hospital. At the time, though, I had no inclination to think that this was active labor and Jen was close to birth. In the end, though, God was watching out for Jen and Libby and me and He overcame all the circumstances, including my stupidity.

Jen, in what I would now categorize as resignation and disgust, starts running the bath. She also mumbles something about "I guess we’re not going to the hospital." While I watch over running the bath, Jen tells me she is going to get in the shower. I am trying as best I can to attend to Jen, and I try to talk with her while she’s in the shower. Two things occur to me in this minute-long stretch that now seem obvious: one, Jen was in Laborland because our conversation was pretty one-sided and Jen was not very coherent (she was standing in the shower with the door open and water was going all over the bathroom floor, when I asked her if we should close the door, she just shrugged); the second thing is that she had a contraction that was at a different level and her perspective changed. I now think that she was in transitional labor from this point forward.

As Jen goes from the shower to the tub she mentions to me that she feels like she has to poop. Another indication that she was not coherent – I asked her what was on the floor and she says "blood" and gets in the tub. I checked it and told her it was poop and cleaned it up. Again, she just shrugged.

The water in the tub is not very warm at this point. One, it’s a big tub and two we had used hot water in the washing machine and the shower before the tub was filled. Jen tells me the water is not hot enough. So what do I do? I fulfill the stereotype of the clueless husband and go downstairs to boil some water.

I keep asking Jen if there’s anything I can do, trying to be as useful as possible. I am standing in the doorway between our bathroom and bedroom, still trying to get Jen to relax and slow her labor down. About five minutes in Jen tells me that she doesn’t like me standing there and watching her. The next 30 to 45 minutes Jen labors in the tub by herself, with me listening from the other room and checking in occasionally. I am praying for Jen’s comfort and for her to relax. Jen has now told me that she was praying and reciting memory verses to herself. The verse she repeated most often was ‘I can do everything through him who gives me strength’ (Phil. 4:13). During this time I can tell that she is having some uncomfortable contractions by the sounds from the tub, but still nothing like screaming or unbearable pain. She is also changing positions as it seems her body tells her. One moment I find her on her hands and knees, another kneeling in the tub, another leaning against the tub wall. Jen also uses the faucet in the tub to splash cold water on her face at regular intervals. And by the way, she never used the hot water I had boiled.

Between 3:30 and 3:45 or so she mentions to me a several things: "I just don’t see how I could do this for 18 hours" "There is no way I can get in the car right now" "I’m exhausted." Of course my answers were extremely helpful and insightful.

As it gets closer to 4am I notice that Jen is putting her had between her legs a couple of times. Later I find out that she feels something down there, and that it is not hard as she expects, but is soft and squishy. At exactly 4am she asks me what time it is. I remember because I looked at the clock on my bed table and it said 4:10 and I set that clock ahead by 10 minutes. Little did I know that the next five minutes or so would become the most amazing thing I had ever experience and change my life forever.

Jen is still in the tub and the water is dirty because of the various things that have been coming out of her. I am standing in the doorway again watching over her. While I’m watching, Jen reaches between her legs and announces to me ‘There is something coming out of me.’ Jen seems upset, but honestly my first thought is not yet panic; it’s more skeptical of this really happening – maybe it was just denial. Very quickly, though, the adrenaline kicks in and my heart rate accelerates rapidly and my mind is racing. I look back at Jen and she seems very frightened and it occurs to me that I need to provide some sense of assurance, that everything is okay.

Having taken childbirth education classes that emphasized natural birth, Jen and I had seen video footage of several dozen births. I had gotten pretty accustomed to the idea and knew that if Libby’s birth was imminent I should see the head crowning .

So I asked Jen, as calmly as I could, to stand up in the tub so I could see what was happening and provide the reassurance I wanted to give her. When Jen stood in the tub, what we observed was not only totally unexpected, but most unsettling and even terrifying. Jen did not have a baby’s head crowning from her body, instead she had what looked like a water balloon protruding from her about 3 or 4 inches. At this point Jen looks at me with a most terrified look and asks "What is that? Is that normal?"

The next ten to twenty seconds are the most completely terrifying moments I have ever experienced. I know I keep using forms of the word terror, but I can’t think of any other word that fits as well. For the first few fractions of a second after Jen stood up I am looking into the abyss. It is one of those life-defining moments that I will never be able to fully describe. The thoughts that flash through my mind are that one, there is something very wrong about what I am seeing and two, it seems very possible that I could lose not only our baby but also my wife in this process.

With these thoughts still passing through my head, I look back to Jen. In my mind I hope she sees a look of reassurance, but I’m pretty sure that what she actually sees instead is complete and absolute terror in a very poor disguise. For a millisecond an impulse to run away passes through me. Keeping up the brave front, I try to assure her that everything is going to be okay and to help her out of the tub. Jen gets out of the tub and I help her walk the four or five steps to the doorway that separates our bathroom and bedroom. Jen still has her hands between her legs and we are both looking there trying to figure out what is going on. I get Jen’s attention and tell her as calmly as I can that we are going to get her dressed and head for the hospital. In my mind, though, my own words sound hollow. Internally I am in a world of fear. I feel like I am a million miles away - somewhere in outer space.

Jen is still standing in the doorway, I think partially using the frame to lean against. The brilliant idea to call someone occurs to me, so I start looking for Jen’s phone. Jen’s phone is the only one that has the doula and midwife’s numbers in it and Jen has recently used the phone to call them, so I figure I can just hit redial. I look in Jen’s purse and on her bed table about five times each in quick succession. It’s obvious the phone is not there, but I am not exactly thinking in a coherent fashion at this point – I am still in outer space, not really present at all. At this point Jen says something that brings me back to the present and reality. I don’t remember what she said. She thinks she said, ‘Here’s the phone,’ pointing to the bathroom counter. Whatever she said was enough to bring me back to where she was standing. I don’t remember whether I was kneeling or just squatting, but I was eye-level with the business at hand. I couldn’t see anything other than a now-bigger water balloon from Jen’s front. Again having seen birth videos it occurred to me that sometimes midwives or nurses sometimes were behind the mother for help, so I went around behind Jen.

The next two seconds or so are kind of a blur and I’m not exactly sure what happened. Since all I have seen at this point is the water balloon (which, in retrospect was probably part of Jen’s bag of waters being pushed ahead of Libby through the birth canal) I was still not sure that Jen was giving birth. Part of me was still thinking that this was some part of Jen that was unnaturally coming out (I was still at the edge of the precipice, looking into the abyss). Somewhere from the subconscious part of my mind, though, came the thought that I ought to catch whatever came out, so I put my hands up under Jen’s rear end.

This is the point at which God did His miracle. In an instant He drove the darkness away and the dawn arrived; He pulled us back from the precipice of the abyss and brought us to His breast and comforted us; He performed His powerful work and proved Himself trustworthy and true.

Just after I put my hand up something soft hits me in the left hand – Libby’s bottom, I’m pretty sure, but it was still covered by part of the membrane, so it wasn’t obvious. The next thing that happens is Libby unfolds and her legs come free into my right hand. Only now can I see recognizable parts and understand that this is indeed our baby being born. I can now hold Libby as the rest of her body proceeds from inside Jen – her torso comes out and then Libby is out up to her shoulders. As her head comes out she hesitates for just a little bit; I think from instinct Jen lets out a quick scream and Libby’s head comes free and she is totally out. I let Jen know "I’ve got her, I’ve got her," with Libby resting in my hands.

Jen asks me immediately the thought that is going through both of our minds, given the extraordinary birth process we just experienced, "Is she okay? Is she okay?" I look closely at Libby and my unspoken prayer is "Please, God, please let her be okay.’ Within a moment Libby starts to wriggle around and move her arms and we can relax and rejoice as I let Jen know "She’s okay, she’s moving around." At that point there is the realization that not only did God watch over my wife to give birth to our daughter at home, but that our daughter was born in a breech presentation at home – miracle of miracles.

At this point Jen is standing just inside our bedroom from the bathroom and I am holding Libby, still very close to Jen’s bottom. We realize we need to have Jen lay down, and there is enough blood and other stuff to make me realize that it would probably be better to have her lay down in the bathroom on the tile than to lay down on the carpet in the bedroom. Jen lays down while I hold Libby and we try to get Jen as comfortable as possible on the bath mats on the bathroom floor. Having covered such a scenario briefly in our birth education classes, I know that the best thing I can do is lay Libby on Jen’s tummy and cover them both with towels, which is what I do. Libby seems to be doing fine and everything is going to be okay. Libby does seem to have some congestion, so I try to get a bulb syringe to get stuff out of her mouth. The thing comes apart while I’m trying to use it, so I just decide to not use it. While I am already up getting towels, I call our doula and tell her Libby was born safely; I also call the midwife’s answering service and ask her to call back. Our doula says she is going to go ahead to the hospital and she will meet us there.

Jen, Libby and I lay together on the bathroom floor for the next five or ten minutes trying to figure out exactly what we’re going to do. One of the most amazing things I have ever seen happens during that time. Libby, all of ten minutes old, is inching her way up Jen’s stomach to her chest to get something to eat. At that point, I knew Libby was going to be okay.

Jen’s midwife has not called us back, so I make another call to the answering service and tell them we had our baby at home can she please call. She calls back in the next minute or so. I describe to her that everything seems okay. I tell her Libby has some congestion and she says that should work itself out and she’ll be okay. I also describe what’s going on with Jen and that she seems to be fine as well. She and I talk through how to get Jen off of the floor, which would entail cutting the umbilical cord. We discuss how to do this and I proceed to tie off Libby’s cord with dental floss, sterilize a pair of scissors with a lighter, and cut the cord.

Our doula tried to call while I was on the phone with the midwife, so I call her back after we have cut the cord. We tell her that we have decided not to go to the hospital, and ask her to come to our house. I hold Libby briefly and help Jen get to her feet. We are expecting the placenta to come pretty quickly, but it does not. So Jen goes and sits on the toilet. While she is sitting on the toilet, she starts nursing Libby for the first time. The placenta had not yet come, now about an hour after birth. Our doula suggests we call Jen’s midwife and get input, and while she’s dialing the placenta comes out. She helps us get Jen to the bed so she can nurse better. She also cleans Jen and the baby and helps us start to clean the bathroom. She stays with us until we have everybody ready to go to Jen’s appointment with the midwife, which was originally scheduled at 9am on that day for Jen’s 41-week checkup.

We get Jen to her appointment with her midwife – not exactly on time, but we make it. She checks Jen out and finds that she only has one small tear and surmises that it should heal okay without any help. She also gives Libby a brief checkup and tells us we have to find a pediatrician and get Libby there before the end of the day. Jen calls around to some friends, gets a recommendation for a pediatrician, and gets an appointment. We are in the doctor’s office at 2 that afternoon. She checks Libby out and confirms that she is healthy and fine. She also urges us to get Libby a Vitamin K shot, most easily available at a hospital. The only unpleasant part of the birth experience was this whole hospital visit. We were extremely excited for how miraculous Libby’s birth was. The ER docs, nurses, etc were not nearly as impressed. In fact I would say the general assessment ranged from moderate disapproval to looks that indicated having a baby at home, even accidentally, was most certainly criminal. We survived that episode, though, then got some food and headed home from one of the most miraculous days I could ever imagine.

A note of appreciation for Teresa

Dear Teresa,

Many many thanks for today's help. I cannot express in words my gratitude
to you.

The way that my wife was relaxed and comforted through her birth and later
was priceless. I will also send you some pictures once I download them.

Thanks again,

V

What Makes for a Successful VBAC?

I would love your input on this article- post to the blog so others can see your ideas... but last night I had a client have a wonderful VBAC and it made me think about what helps make a VBAC happen... here are a few ideas to ponder:

Choosing the right care provider. I put this first because I think it is paramount! Ask your doctor or midwife a few questions- how often do their previous cesarean patients choose to go for a VBAC? How many are successful? Do they enjoy working with moms who choose VBAC? Often times a care provider may say they are supportive but their numbers will show a lot. Often times they change their tone as you become more pregnant. Or they support it only if you birth by your due date- going over your due date is not acceptable. Some will help you into labor if you desire with breaking your water or low dose of pitocin. Others will only schedule another cesarean if you do not birth by your due date. Make sure they are really on board. Make sure you are a good candidate for a VBAC in their view before you proceed.

Choose a doula. It may be helpful to choose one with experience with VBAC but supporting a woman is universal- but having a doula there to help encourage you- to help remind you of your ideals- to help you in determining what may be considered in labor- these help. The studies show a doula reduces the chance of the initial cesarean but I think having one for a VBAC is essential for most couples. They are there to support the partner as well as the mom.

Take a preparation class for your VBAC. Read about how to help you achieve this. Learning techniques that help to align the baby properly- (www.spinningbabies.com), taking a yoga class or a mediation class that will help you get in touch with a mind body connection before hand will help. Take a class, especially if you did not take a childbirth preparation class the first time- techniques to help with pain will be beneficial. Also classes that help you process ideas and concerns- even fears that may be hidden will help.

Keep fit. If the reason your baby did not come out vaginally last time was due to the size- or at least the reason you were given- consider watching your diet closely to help you gain healthy weight- not bulk weight- and keeping your diet in check is good but so is keeping healthy and exercising to keep you fit.

Consider what worked last time and do it again- and consider what you felt hindered you last time and remove it. For instance if you had people with you last time that did not fully support you in the birth ideals you wanted... don't invite them back this time. If your partner was not on board last time with your choices- help him or her get on board this time in order to be the support you need. If you arrived too early last time to the birth location, consider staying home longer this time.

Work through your worries before you birth. Often times folks say they have no worries. The fear or worry may be hidden- but it comes out during labor. So, work through your thoughts. Think about how you want your labor to unfold. Consider what you can control from your previous birth this time. Consider how you will handle things differently this time. See yourself coping differently. There is so much fear around having a VBAC... some need to be addressed and some need to be researched to determine their veracity. Do the research so you will know what is true for you.

This type of preparation helps you achieve the birth you desire whether trying to achieve a VBAC or a vaginal birth anytime. Set yourself up to win.

VBACs don't usually just happen- they happen most often when women set themselves up to win!

I welcome comments from those who have VBAC'd and those who help women achieve this experience.

"best laid plans always fail"

You know they say "best laid plans always fail"?

I had a "best laid plan" for the birth of Little Miracle. I hired a
doula, switched to a midwife that does water birth, had taken all the
classes, read all the books, and was ready for my HOSPITAL water birth
with my doula and midwife there.

I didn't get it.

12/7/09

I cleaned the house tonight when Stephen took Little Man to the gym. I
was having a few contractions, but I was having them all week. They
would come and go, nothing consistent. After I cleaned, I sat on the
birth ball for a while. Bouncing. Swaying. Doing anything I could do
to get the contractions to come back and stay consistent. Nothing was
happening, so I decided to give up and go to bed. I had seen my
midwife that morning, and I was 2-3 cms, but she stretched me to 3-4.
She said she would "see ya tonight" but I did not put faith into it.

I went to bed at 9:30. I say went to bed, but I just laid there and
tossed and turned. I was uncomfortable. I was 40 weeks and 2 days
pregnant. I wanted to get the show on the road! Little did I know the
show was on its way, coming down the fast lane.

I was just about to drift off to sleep around 11:15 to 11:30 when I
felt a contraction. Hum, I usually don't have them when laying down.
And this one was getting painful. I got up and went to the bathroom. I
had another fun sign of labor approaching in the bathroom, so i knew
something was happening. I texted my girlfriends that I think
something was up. This was 11:42 pm.

I filled my tub and crawled in hoping to labor at home for a while. I
told my husband to get the computer and to start timing the
contractions. By midnight the contractions were 2 minutes apart
lasting about 2 minutes each. Hum. Maybe time to call some people!

12/8/09

Stephen called my mom (to come and watch Little Man) and our doula and
midwife. Looking at my phone, he called my mom at 12:13, the midwife
at 12:19 and my doula at 12:21. (My water broke when Stephen was on
the phone with our doula) My mom was on her way, my midwife said get
to the hospital. The contractions were coming so fast, and starting
out SO hard, I just knew there was NO way I could do this naturally. I
begged Stephen to get me to the hospital and to get me an epidural!

I suddenly felt the urge to push. I never felt this with Little Man
since I was so drugged, and I did not believe that I was feeling it.
It was too fast. There is no way I was fully dilated!

I pushed once and put my hands down there. I felt his head bulging me
outward so I told Stephen to call 911. He didn't believe me when I
told him I NEEDED to push. He was telling me to just hold on and we
would get to the car, and to the hospital. He did not believe that the
baby was coming either.

I pushed again and felt his head crowning. At this point Stephen was
on the phone with 911. I don't know when he realized that I was not
kidding, and called 911. He told them "my wife's in labor".

I pushed again and his head came out. I was in SHOCK. OH MY
GOODNESS!!! I was having him in my tub at home! All these thoughts
came to mind. I am at HOME, in my tub, with NO MEDICAL PEOPLE PRESENT.
What if he gets stuck? What if the cord is wrapped around his neck?
What if I can't get him out?

I gained my composure, and knew that I could do this. I knew what to
do. Almost like instinct.

The next contraction came and I pushed out his body. I had my hands
down there to catch him and pull him up to my chest. I rubbed his head
and Stephen patted his back. Stephen was still on the phone with 911.
He told them that the baby was born! I asked Stephen what time it was.
I wanted to know the exact time I had him. It was 12:30 am.

He let out the tiniest little cry. I knew he was ok. I pulled him off
my chest to check for his cord. It was around his shoulder, but not
his neck. I untangled him, and put him back between my breasts and
covered him with a towel that was on the side of the tub.

Stephen went downstairs to let my mom in (who had been trying to knock
for a few minutes, and even called, but we never heard her) and wait
for the ambulance.

My mom came upstairs and saw him. The look on her face was priceless.
I don't think she believe that I just delivered a baby in the tub at
home either!

The paramedics got there a few minutes later. I still had Little
Miracle on my chest and covered so we stayed that way for a few
minutes to try to wait for the placenta. The paramedics were very nice
and were doing things on my time. After a few minutes they suggested
that we go ahead and cut the cord so they could check on the baby. I
agreed and they clamped it. They went to cut it (with a razor blade
they had!) I stopped them, and asked if Stephen could cut it. They all
looked at each other (there was about 4-5 men in my bathroom... all of
them with a look of disbelief and shock on their face... I don't think
any of them had ever seen a call like this before, either that, or
they were just happy they did not have to deliver a baby) and someone
finally said "Well I don't see why not" and handed Stephen the razor
blade.

The one female that was there with the paramedics took Little Miracle
and wrapped him up in a foil blanket. She took him to the master
bedroom. We (the men and I)waited about 10 minutes for the placenta
and it was not coming, so they loaded Little Miracle and I up into the
ambulance to head to the hospital. I told them which one I wanted to
go to, and away we went.

I held Little Miracle on my chest skin to skin the whole ride down. I
was having contractions still, but they were no where near as strong
as the ones I had just had. We finally made it to the hospital, and my
doula showed up, then Stephen (he had to follow in our car) then my
midwife.

The placenta took what felt like forever, but it was nice to have my
doula there to help me thru the contractions. Once it came I felt SO
much better! My midwife had to sew me up because he came so fast that
I tore. I did not feel it when it happened, because his head numbed me
on the way out.

The female paramedic was finishing up her paperwork and talking to me.
She said that the initial call she got was "woman in labor". Then she
said not even 30 seconds later, dispatch said "woman delivered". She
said she had to question dispatch "Woman delivering, or delivered?"
because she did not believe it either!

By the time my midwife was done sewing up my nether regions, it was
all starting to sink in. I had a baby! At home! In my bathtub! With no
one there! In less than an hour! Now that's a feeling! Talk about on
top of the world. I still want to stand on top of the roof and shout!
I DID IT! Granted, not how I had planned AT ALL, but either way, I did
it!

He was born at 12:30 on the nose. 7 lbs 6.9 ozs 19 inches. Perfectly healthy!

http://lifeofasahm-lisa.blogspot.com/2009/12/you-know-what-they-say-about-best-laid.html

Epidural consent form

There was recent conversations regarding informed consent. Often times if a mom chooses to get an epidural it will be after she has been in a situation where she is hurting and it is hard to make a decision much less read the form- so here is a form from http://www.gentlebirth.org/archives/epdrlrsk.html for you to read now so you understand the risks involved.


Epidural Consent Form

Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.

CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION



1. I authorize the performance upon _________ of the following

procedure ______________ performed under the direction of

______(physician's name).



2. I consent to the administration of local anesthetics, narcotics,

and/or other medications into the epidural space.



3. I understand that the following, among others, are possible

complications or risks of the procedure and that while they are

uncommon, they have been reported in the medical literature:

-Failure to relieve pain.

-Hypotension (low blood pressure).

-Postdural puncture (spinal) headache which may require

medical therapy.

-Persistent area of numbness and/or weakness of the lower

extremities.

-Temporary nausea and vomiting.

-Breakage of needles, catheters, etc. possibly requiring

surgery.

-Hematoma (blood clot) possibly requiring surgery.

-Infection.

-Rapid absorption of local anesthetics causing dizziness

and seizures.

-Temporary total spinal anesthesia (requiring life

support systems).

-Respiratory and/or cardiac arrest (requiring life

support systems).

-Back pain.

-Fetal distress resulting from one of the above complications.



4. I consent to the performance of procedures in addition to or

different from those now contemplated, whether or not arising from

presently unforeseen conditions, which the above named doctor or his

associates or assistants including residents, may consider necessary or

advisable in the course of the procedure.



5. The nature and purpose of the procedure, possible alternative

methods of treatments, the risks involved and the possibility of

complications have been fully explained to me. I understand that no

guarantee or assurance has been given by anyone as to the results that

may be obtained.

Notes from Midwifery Today tape on epidurals

After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.

Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.

Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.

Epidurals require catheters, which can require antibiotics, which may interfere with nursing.

Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.

Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)

Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.

Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.

Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."

You lose endorphins and euphoria.

Doulas Being Advocates

Recently I received an email from a potential doula client that started like this, “I am looking for a doula to advocate for me and my husband's wishes in the hospital, and for the baby during labor.”

When I replied with a statement, “Why do you feel you will need an advocate to share your wishes in your labor? A doula will not speak for you- you can speak for yourself- if you can't then your partner will do so- we support you- we remind you of what you wanted- we help you find your questions to find your answers- but if you feel some need to be protected we need to discuss why that is- let's talk more about this.” She was taken a back and emailed me back this, “I think there has been a misunderstanding, I have no problem speaking up for myself; I don't know where that came from. I have a list of questions to help me find a doula. What I'm looking for is a good fit, the optimal organization, because I am assembling my team, and would like a doula present. And I don't know where this inference of needing to be "protected" came from? “

This made me think about the word advocate. Perhaps there was a misunderstanding of that word. When someone says initially something like they need an advocate to be with them- it sends up a red flag. My thesaurus lists these words: supporter, backer, promoter, believer, activist, campaigner, and sponsor. One who would support, encourage and be in favor of. I do think a doula can be these things. I do think there was a misunderstanding.

But this email came on the cusp of hearing from one of my doulas about a couple who had hired her. The father to be was initially one who was gun ho on having a very medicalized birth where all decisions were given over to their doctor. And then as they began to examine more of the birth journey- they had begun to explore options available to them and find out more about birth; he had changed quite a bit. The mother to be wanted a low intervention birth and was hoping to have a gentle vaginal birth in the least and was considering going natural.

Well after going a week past her due date and sharing how her care provider was not pressuring her to do anything to push this labor along, she went in for her 41 week prenatal appointment. After doing a non stress test and biophysical, it was determined that the amniotic fluid level was low- actually he admitted it was just what they expected it to be- well within the normal range- but lower than weeks earlier- but he suggested that they go straight to the hospital for an induction.
Her cervix was not ripe- but they could ripen it with cervidil. And after less than the suggested eight to twelve hours, it was removed and pitocin was started to bring on contractions although her cervix had not changed nor was it any more ripened than it had been the day before. The consideration of a second dose of cervidil was not discussed. And sometime in the night, her water had either been broken or had released due to the cervidil.

The pitocin was bringing on mild contractions initially since the couple had been requesting a slow start to the pitocin. But by mid morning, when the doctor made the decision to bring the pitocin up to normal management levels, the mom was struggling with the pain and the baby showed a few signs of also not being happy with the plan. The doctor had even said these contractions were like those of a mom who was close to pushing, but her cervix remained closed and unchanged. An epidural was placed and the doctor told them he would give them until 2pm to make some progress or she would have a surgical birth. I am unclear as to why this time was determined to be the magic hour of calling for the surgical birth- ACOG says a mom should have eighteen hours to be in active labor after her water was broken- perhaps he had broken her water at 8pm the night before.

Now mind you, they were in very little contact with their doula, and she was not with them- she was awaiting them inviting her to come be with them- whenever they needed her- she was ready- but they felt they did not need her yet. For inductions it can be tricky. Cervical ripenings is usually done while the mom sleeps. And the early onset of a pitocin induction can take hours before a mom even feels the first "real" contraction. So not having a doula present for the early parts of an induction is normal. But after several calls to them to help her know what might be occuring, she was finally able to find out at 3pm that they were going in at 4pm to have a surgical birth.

The doula was disappointed to have not been invited to be a part of this birth. What had happened? She was trying to be that supporter, believer, campaigner and encourager that they had wanted. But no phone calls had invited her to do so. And this care provider who was not going to push her into labor was now pushing her bed into the OR. But this was not the doulas's birth. These were not her choices to make. She could not make these decisions for them. But had they been adequate advocates for themselves in the midst of this situation?

It is hard to be an advocate if someone will not be their own advocate. A doula can not step in and throw herself over your bed and say no. She can not give you medical advice. She can not speak up when you fail to do so. She can not save you from the choices you make freely along the journey. And sometimes I think folks hire us to do just that. I was trying in this email to be clear about our role. The antonym to advocate is opponent and discourager. Sometimes we find the folks we choose to be with us may very well be those things- whether it is the care provider or a friend or family member.

I can reassure you that will not be us- we will support the choices you make in your pregnancy and labor. We will remind you of what you desired. We will assist you in getting your questions answered and considering what your options are along the way. If you are desiring that, then we can be your advocates.