In October of 2009 I posted a letter sent to me by Kelly, a mother who, at 35 weeks of pregnancy, was startled, hurt, confused, angry, and scared to find out that her supposedly VBAC friendly obstetrician was actually leading her on the whole time….
I’m a day short of 35 weeks pregnant today and went in for an OB appointment this morning. My doctor said that if I don’t go into labor on my own in my 39th week that (depending on how much and if my cervix is dilated) she might put me on pitocin- although she did say that “they don’t induce labor for VBAC patients”. But that they won’t let me go to 40 weeks, and that by 40 weeks they will have to schedule another c-section for me. (I live in Cedar Falls, IA)
I am shocked and angry! First of all- since when is 40 weeks, too late? My OB says it’s not wise to go to beyond 40 weeks due to increased risk of uterine rupture. But this just sounds like B.S. to me!
And how does the doc get away with not telling me something important like this until NOW? Unbelievable!! My doctor and I have already gone through my birth plan, line by line, because I want as few interventions as possible and no drugs, seeking a natural vaginal childbirth. I’ve taken 12 weeks of Bradley method birth classes to help my husband and I be better prepared this time. I also have a fantastic, knowledgeable, and supportive doula. But I can’t believe what a fight it is to have a VBAC!
If I had known sooner that this was the doctor/hospital policy for VBAC, I probably would have gone somewhere else. Since it’s so late in the game now, I’m probably going to stick it out. I don’t have to do anything they say, I can always stay at home and come in when I’m ready, and that will be after I am already in deep labor on my own.
I was just wondering if perhaps this reflects a change in my hospital’s policy for managing VBAC? One of the other OB’s I met with at the hospital said that after a high maintenance VBAC patient a few months ago (who also insisted on a natural vaginal childbirth, and did it, but most of the hospital staff were very unhappy dealing with this patient…?) that the hospital is reviewing whether to allow VBAC at all. I’m probably not helping the situation by openly trying to avoid their planned interventions. I KNOW I’m required to have continuous electronic fetal monitoring… but I’ve also been told that my labor has to be pretty much “text book” regarding continuous dilation of my cervix, and of course no tolerance for fetal distress…or else!
I just wish all women would know this before their first c-section. If you thought recovering from a c-section was bad, wait till you try to have a VBAC and deal with the red tape and lack of support from the medical community. It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!
Have you heard of this kind of change in management of VBAC? That VBAC isn’t even allowed to go to 40 weeks?? Thanks for writing such an informative, educational blog and for being so supportive of natural childbirth! I have enjoyed your tips and insight from the hospital perspective (about writing birth plans, and managing your OB, and also the many ways hospital staff really will be supportive- even if you barf!).
I replied to Kelly in my post entitled “The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On” with words of encouragment and some information about other scare tactics that some health care providers use to intimidate VBAC planning mommas. My main message was this:
“You deserve the opportunity to have the unmedicated, intervention-free birth that you have planned for. Your desires for said unmedicated, intervention-free VBAC are well supported by the research. You deserve to be cared for by a birth attendant who shares your philosophy regarding (among other things) childbirth and VBAC. You deserve to NOT have to worry about fighting anyone to be given a fair chance at having the birth you have been planning…not the hospital, not the nursing staff, not your obstetrician, NOT ANYONE. You deserve it for THIS birth. “
Fast forward 4 months. I was struggling with the thought of returning back to blogging as NursingBirth. I was working for a hosptial with a 40% C-section rate. I was feeling powerless. Until I saw this in my inbox…..
Hope you still plan to come back after you settle in from your move- we miss your great posts!
Also, just wanted to say thank you -again- for posting about my comment awhile back! I wanted to update you and tell you that I had a successful VBAC! Thanks for your suggestions, resources, and support!
Needless to say I was touched, proud, empowered, honored, and ESTATIC!!! There is no doubt in my mind that Kelly’s email was a main factor in my decision to return to blogging as well as take the plunge and start yet another new job! So thank you Kelly for being just as much of an inspiration to me as I was to you!!! I am so lucky to be a part of this awesome community we call the “birth blogosphere” 🙂
This month’s Healthy Birth Blog Carnival is “Walk, move around, and change positions throughout labor.” This is a repost from a story I wrote back in March however, I feel like it is a really great example of how important movement and position changes are to a successful labor and birth, especially a vaginal birth after cesarean (VBAC)! This story has been a popular posts with my readers in the past and I hope by participating in this blog carnival it reaches and helps empower more and more expecting women out there!! In reposting this story I have highlighted all the times where Alyssa used upright positions and movement to cope with pain, help her uterus contract more efficiently, help her baby find the best position in her birth canal, use gravity to her advantage, and be an active participant in her labor! And there is no doubt in my mind that all of these things helped her have a safe, positive and empowering VBAC experience!
Last week I had the honor to be a part of one of the most beautiful VBAC(Vaginal Birth After Cesarean) hospital births I have ever witnessed. I would like to share that couple’s story with you today as both a feel-good tale of personal triumph and a story of inspiration for all those moms planning a VBAC out there that might stumble upon my blog. Since this is a blog about “a nurse’s view from the inside” this story is probably much different than any other birth story you might have read from the mother or father’s point of view. But then again, maybe that isn’t so bad! Enjoy!
It was ten to 11 o’clock am as I walked through the lobby doors of the hospital I work at, rushing towards the elevator so I could punch in on time. As the elevator doors started to close, a hand shoved through the crack, forcing the doors back open. “Please make room!”said the woman, a phlebotomist who works in the hospital, in a shaky voice, “Woman in labor here!!”Following behind was a very pregnant woman, huffing and puffing as she waddled into the elevator, followed by what looked like her husband and her mother. “Don’t touch any buttons!”said the phlebotomist, “We’re going right up to labor & delivery!” Since that was where I was headed too, I smiled at the husband and said, “Don’t worry, you’re here now and she won’t have the baby in your car! I work up on L&D so I’ll show you were to register.” Something told me that if this woman was truly in labor then she would be assigned to me since I was just starting my shift. But she had to “pass” triage first, so after helping the family to the registration desk, I hurried into the locker room to change into my scrubs.
Fifteen minutes later the triage nurse came to the main desk, “I’ve got a term mom, 40 weeks 5 days, who’s five centimeters,” she said, “We’re gonna need to put her in a room…. And she’s a VBAC with a ‘birth plan’.” “I’ll take her!,” I said excitingly, knowing that I have my bestdays when I can assist a woman through labor, as opposed to getting stuck on the OR team or in the high risk ward running magnesium. (Not that those women don’t need a lot of TLC too, it’s just that I like labor the most!) Birth plans, natural unmedicated labor, and getting my patients out of bed…those are my specialties!
I quickly set up the room across the hall as the resident finished the patient’s history and physical in the triage room. Then I quietly knocked on the triage room door and let myself in. The patient, Alyssa*, was standing by the bed, rocking her hips back and forth, as the continuous monitors strapped to her abdomen traced the baby’s heart rate and her contraction pattern. It looked like she was contracting every 3 minutes, and the baby’s heart rate was beautiful and reassuring. Her husband, Jared, was leaning nervously against the wall and her mom, Deb, was sitting quietly in the corner. I could really tell that Alyssa was lost in “Laborland” and I wanted to make the transition to her room as seamless as possible as to not break her rhythm and concentration too much. I quietly introduced myself and with the help of Jared and Deb, moved all of their belongings across the hall as Alyssa waddled behind.
I could tell that Alyssa was coping well with the contractions while standing but a quick glance at her prenatal summary revealed that she was Group B Strep positive and would need IV antibiotics (our hospital’s policy and the midwife’s order) and hence, and IV. Now I feel that I am pretty skilled at starting IVs, but I have not yet mastered starting an IV with the patient standing and swaying! So in the two minutes between the contractions, I explained to the Alyssa what I needed to do before the admission process was complete: get 5 more minutes of continuous monitoring on the baby (to equal the “20 minute strip” my hospital’s policy requires before we can switch to intermittent auscultation), take a set of vital signs, draw three tubes of blood, start an IV, and ask a few more questions. “Give me 8 minutes sitting on the bed,” I said, “and I can have everything but the interview done. The rest of the admission can be done with you standing up.” “Okay,” she said, “I can do eight minutes.” Eight minutes later the IV was in, antibiotic running, labs drawn and sent, vital signs done, monitors were removed, and the patient was helped out of bed (Phew!! That was close!! J). And it wasn’t a moment too soon because Alyssa was having a lot of back labor and sitting in bed was just making it worse!
Then there was a knock at the door. Here’s how the subsequent conversation went down…
Me: “Who is it?”
Med Student: “It’s just the medical student,” (said as he walked right into the room)
(I hadn’t yet gotten a chance to ask Alyssa if she was okay with medical students so I just kind of looked over at her and Jared and tried to judge their reaction.)
Med Student: “Hi I’m Michael. I have to ask you a few questions.”
(Have? How about “Is it okay if I ask you a few questions? Sheesh!!)
Med Student: “Are you being induced today?” (asked as he stared down at his paper)
Alyssa: “INDUCED! DOES IT LOOK LIKE I AM BEING INDUCED!”
Med Student:“Okaaaaay. Umm, any problems with this pregnancy?”
Jared: “Do you really need to ask these questions right now? The resident already asked her that stuff.”
Med Student:“Umm yeaaaah, I do. There is a lot of repetition but we have to ask again.”
Deb: “Doesn’t her prenatal summary tell you all of that?
Med Student: “Ummmmm….”
Me: “With all do respect, Michael. But I think they are trying to tell you that they do not want any medical students. Or anymore residents for that matter. Okay? So I think we are done here.”
Med Student:“Ummm, what am I supposed to tell the resident?”
Me: “Tell her I said that the next induction that comes in is all yours.”
As the med student left, Jared, Deb, and Alyssa all looked at me simultaneously and said “THANK YOU!” “I don’t think he was getting the hint,” said Jared. “Yeah,” I said, “I figured he needed it spelled out.” In hind sight, I think this was one of the moments that really helped me to bond with this family because after all, I understand how difficult it must be for families to come into the hospital and have to work with a nurse that they have even never met during one of the most intimate experiences of their lives!
I spent the next fifteen minutes finishing up the patient’s admission assessment as quickly as I could. I told Alyssa that if she was having a contraction to just ignore me, and asked Jared to help answer any questions he knew the answers to. (Unfortunately, our hospital’s pre-registration does not include performing an admission assessment and hence, it has to be done on arrival to the hospital. Usually, if a patient comes in for false/early labor a time or two, it gets done then but Alyssa had not been to the hospital her whole pregnancy, which is great, but it meant that I did have to bother her with some silly questions during labor. Kind of a bummer, but with the help of Jared, it went pretty smoothly.) It was during the admission interview that I found out some of the details of Alyssa’s pregnancy and prior cesarean section. Alyssa had an unremarkable health history and a normal, healthy, uncomplicated pregnancy. She was a G2P1, but since her first baby was born by cesarean section, she technically was considered to be a “primip” (healthcare slang a woman who is about to deliver her first baby) regarding a vaginal delivery.
Jared told me that when their son was born two years ago, Alyssa was persuaded into an induction at 39 weeks for “LGA” (a.k.a. large for gestational age, which by the way is NOT recognized as an appropriate indication for induction of labor by ACOG), was first given a few doses of misoprostol to “ripen” the cervix, followed by pitocin to stimulate contractions and continuous external fetal monitoring to monitor those contractions, then given a couple doses of Stadol and eventually an epidural for the pain, followed by artificial rupture of membranes to place a fetal scalp electrode after the epidural dropped Alyssa’s blood pressure and caused a prolonged fetal heart rate (FHR) deceleration, then an intrauterine pressure catheter to assess if the pitocin induced contractions were “adequate”, and eventually a cesarean section after 1 hour of pushing in a back-lying position for “failure to descent & cephalopelvic disproportion (CPD).” Thirty minutes later baby Kevin was born at approximately 2:00am, weighing in at 7lbs, 5 oz.
In my opinion, Alyssa was a victim of the “cascade of interventions.” Many maternity interventions, including elective induction, pain medication, artificial rupture of membranes, epidural anesthesia, back-lying positions for labor or for birth, etc. have unintended effects. Often these effects are new problems that are “solved” with further intervention causing a domino effect that ends up creating yet more problems. This chain of events has been called the “cascade of intervention” and unfortunately often leads to vacuum extraction/ forceps delivery, episiotomies or 3rd or 4thdegree tears, and even cesarean section. Many of these women are often also then mislabeled with diagnoses like “CPD,” “failure to progress,” “failure to descent,” and at the end of it all, the obstetricians turn around and say, “Thank God we were in a hospital; look at all the technology we needed! So when will your repeat cesarean be??”
This time, however, things were different. After the birth of their son, Alyssa and Jared started to research more about labor and birth, VBAC, and natural birth. They interviewed and chose a doctor (Dr. Z) that was supportive of natural birth and VBACs, with the statistics to prove it! And here they were now, at my hospital, ready and rearing to go! Alyssa said that for the past few days she had been having contractions “on and off” but that they really started to get going at 8:00 am. When the resident had checked her on admission, her water spontaneously broke during the vaginal exam at 11:15am. It was now 11:45am and Dr. Z’s midwife entered the room. Although it had only been 30 minutes since her last vaginal exam, the midwife decided she would check Alyssa again since she seemed pretty active. And boy was she ever! The midwife’s exam showed that Alyssa had progressed to 7-8 centimeters! “I don’t think I can do this anymore,” Alyssa softly whimpered to the midwife. We all reassured her that she was doing so well and that things were getting more intense for a reason and to stick with it!!
The midwife then offered to help Alyssa into the shower to help alleviate her back pain. Alyssa seemed skeptical at first but we assured her that if it wasn’t helping, that we could get her right back out. So Alyssa agreed and the midwife and I, along with Jared, helped the patient into the shower. What happened for the next hour was one of the most beautiful displays of love, perseverance, hard work, and dedication I have ever witnessed. Alyssa turned her back to us and rested her hands on the grab bar on the shower and her head on the shower wall. Her cadence was this: Between contractions she would sway side to side, as if she was slow dancing. During contractions she would squat up and down, up and down, moaning in a low tone as she carried out her ritual. She just moved with the rhythm of her labor, listening so instinctively to what her baby and her body were telling her to do.Jared used the hand held shower head to spray Alyssa gently with a stream of warm water up and down her body, concentrating mostly on her lower back. I quietly entered the bathroom a few times that hour to check the baby’s heart rate with the portable doptone, trying hard not to disturb Alyssa’s concentration. Mostly, however, the midwife, her mother, and I stayed outside the bathroom door as to give Alyssa & Jared the privacy they needed to facilitate the progress of her labor.
At 12:35pm Alyssa told me that she was starting to feel a strong urge to push. The midwife entered the room and as Alyssa knelt in a hands and knees position in the tub, the midwife checked her cervix. To everyone’s surprise Alyssa only had an anterior lip of cervix left to go (this means she was about 9 ½ centimeters dilated)! After the next contraction, Jared and I helped Alyssa out of the shower to the toilet where we both used warm towels to dry her off. Then Alyssa walked over to the bed, “Can I kneel on my hands and knees?” she asked.“Sure!” we all said in unison, as we helped her up onto the bed. “I feel like I have to push!” Alyssa said convincingly and when the midwife checked her cervix, the anterior lip was gone…Alyssa was fully dilated at 12:45pm, only 1 hour and 55 minutes after arriving at the hospital! “You can start to push anytime,” said the midwife.
One of the best things about being a part of this experience was the fact that it was one of the only times that I have been present at a delivery where that a birth attendant has allowed the mother to use spontaneous or mother-directed pushing, as opposed to directed pushing. I knew that Alyssa was interested in using a variety of pushing positions for the second stage of labor from her birth plan and for the next hour and a half the midwife, Jared, Deb, and I helped Alyssa get into a variety of positions including right/left side lying, squatting, hands and knees, and kneeling.
(Side Note: I would like to digress for a moment to point out how important it is to be physically fit during your pregnancy whether you are planning for a natural birth or not. Many a woman I take care of blindly fills out a “birth plan” they find online where they can click on the boxes for options that sound “good” to them, without actually researching or thinking over what they are writing down. For example, they say that they want to try squatting during labor and birth, but couldn’t even do a squat at the gym pre-pregnancy. Although it is definitely true that a woman can sum up and realize an incredible amount of strength during labor and birth related to not only hormones but also sheer will power, it should also be known that labor is HARD WORK and pushing out a baby is HARD WORK which both require a great deal of physical strength and stamina. This is yet another reason why it is so important to follow a modified exercise plan and eat a healthy well balanced diet rich in protein and omega-3 fatty acids before, during, and even after your pregnancy.) Let’s continue with Alyssa’s story…
What was so amazing was that although there were plenty of times during the labor and pushing phase that Alyssa would doubt her ability to go on (“I can’t do this anymore!” “The baby isn’t moving?” “Is the baby moving?” “I am so tired!”), she never gave up on herself. Each time she made a comment like that, we all took it as a request for more support. And every time we gave her more encouragement, cheers, and reminders of her progress and goals, (“Keep going!”, “You are doing so well!”, “We can see so much more of the baby’s head!”, “She has lots of hair!”, “Just a few pushes more”, “You are so strong, you are going to do this!”, “You can do this!”), she found the ability to keep going! Towards the end of the pushing stage Alyssa was (understandably) exhausted and was pushing in a modified lithotomy position while Jared and I supported both of her legs. Then all of a sudden Alyssa popped up and said (and I quote)…
“I need GRAVITY! I need to be UP!” as she sat upright into a full squat and
PUSHED her baby’s head out with one gigantic ROAR!
“Whoa, whoa!” the midwife and I said almost simultaneously, “Easy, easy, baby pushes.” “Blow like you are blowing out birthday candles,” I said. The midwife checked for a cord around the neck (which there was none) and cleared the baby’s mouth and nose. And with only a few more “baby pushes” Addison Joy was born at 2:27pm!
The room erupted into cheers of excitement and tears of happiness! I put the baby skin to skin on mom as I dried her off with warm blankets and cleared her mouth and nose with the bulb suction. A quick palpation of the baby’s cord revealed that her heart rate was nice and strong and she was pinking right up! Jared and Alyssa kept hugging and kissing each other and talking to their new baby girl, “Hi Addison! Hi baby girl! I am so glad to finally meet you!” The midwife waited until the cord stopped pulsating before she cut it (per mom and dad’s birth plan) and then checked Alyssa for any tears. Except for some swelling, she only had a small tear on her right labia that didn’t even require any stitches!! We kept mom and baby skin to skin for a full hour after birth and baby Addison nursed almost the whole time. When she was an hour old, I weighed her to satisfy mom’s curiosity and to everyone’s surprise the baby weighed 9 lbs 3 ozs!!!
So much for “cephalopelvic disproportion” huh!!
And it was as I handed baby Addison back to Alyssa that she looked up at me and said softly, “I needed to know my body could do it. I knew my body could do it! I really needed this. Thank you.” So as you can imagine, I started to well up. I have never felt so honored to be a part of something so special. What a privilege to have a job where I witness the miracle of birth and the miracle of motherhood every week!
So let’s recap shall we. Alyssa, after having a cesarean section for her 7 lb 5oz son two years earlier for “CPD” and “failure to descent”, pushed out a 9lb 3oz baby after a 6 hour and 27 minute labor, including 1 hour and 42 minute of mother-directed pushing, without any pain medications or an epidural, monitored by intermittent auscultation, needing not a single stitch to her perineum! Her tools included good and relevant labor & birth preparation, appropriate and helpful family support, sheer strength, determination, and will power. The midwife’s arsenal included extensive knowledge of and experience with natural birth and labor support, a doptone, a trust in birth, and a belief in Alyssa’s ability to do it! No medications, no vacuums, no scalpels, no scissors, and no doubt!
Like always, I woke up this morning and sat down in front of my computer with my bowl of Cheerios to check the comments left on my blog. I was pleased to see that I had a few comments about that post. One in particular however, actually brought me to tears. I was especially moved by her “garden” metaphor. (I know, I am such a sap!)
Alethea is from Colorado and has been working with birthing families as a labor and delivery nurse for the past 8 years. When she comments on my blog, she often writes about how she is truly inspired and amazed by the power of birthing mothers. She became a trained BIRTHING FROM WITHIN® mentor out of her desire to help guide more women along the path of empowerment through their birth experiences. Alethea is also a co-founder of Colorado Conscious Birthing.
I think I was so moved by Alethea’s comment because I feel the same way about being an L&D nurse as she does. Witnessing the miracle of life, the power, strength, and determination of women, and the overwhelming love of family and friends as your job is pretty amazing. And I love it. Even when I am having the worst day imaginable, I still love it.
So I just couldn’t let this comment die, hidden away for only a few stragglers to read as they come across the old blog post. I hope you enjoy it as much as I did! It really brightened my day!!
This post spoke to me in ways that I can not express in written word, but I will try. I also am all four of these women you write about.
1) As a woman who has yet to give birth. The power of a woman giving birth the way nature intended (regardless of the setting) takes my breathe away every time. This was a beautiful, inspiring, empowering montage. I hope to some day be empowered by my own strength and beautiful birth.
2) As a labor and delivery nurse. My inspirational theme song is Ben Harper’s With my own two hands:
…”I can change the world, with my own two hands. Make a better place, with my own two hands…make a kinder place….I can make peace on earth…I can reach out to you….gonna make it a brighter place, gonna make it a safer place, gonna help the human race… with my own two hands…I can hold you…I can comfort you…but you got to use, use your own two hands…”
Empowering women to search inside themselves and tap into their deep well of intuitive knowledge and strength is what keeps me coming back for more despite how tired, burned out, and sick of the politics I might be. Forgetting the hustle and bustle outside in the hallways, my job is to delicately plant the seed that they can do this, they are strong, they are capable. Bearing witness to the strength and power that women are capable of is an honor. I am an advocate of normal birth, an advocate of women, an advocate babies and daddies and doulas and new families. I am a labor and delivery nurse because I love supporting women with my own two hands, occasionally being lucky enough to be the first human to hold new life in my own two hands, but especially helping to break the cycle of doubt and fear in order to inspire women to understand that they can birth with their own two hands (or on their own two hands and knees).
3) As a labor and delivery nurse who has yet to experience birth. It seems to me that because Lindsey is a home birth midwife she had the distinct advantage of seeing mostly normal, natural, beautiful births to inspire her. And yet she still had that little seed of doubt threatening to take over her mind. Like a weed in a garden, we have to pull up those seeds of doubt so they don’t take over our beautiful gardens. We must lovingly attend to our gardens (growing baby, growing minds) nurturing the beauty, inspiration and trust. Sometimes we pull up a weed, but we don’t get the entire root, and it comes back, even stronger and with a vengeance. Threatening all the beauty and strength we have worked so hard to grow. Pregnant and birthing women need to surround themselves with people who want to help tend to the garden, and avoid people whose defeatist attitudes are apparent in their neglected gardens (minds, attitudes) full of weeds (doubt).
Working in the hospital we do see a lot of “failure”. Failure to progress, arrest of decent, fetal growth restriction etc, etc, etc. The weeds (negative thoughts) in the hospital birth culture are rampant. It takes even more hard work and dedication for those of us immersed in it to remember that the majority of birth could be normal and natural and beautiful if we nurtured and support physiologic birth and weeded out unnecessary intervention. I am confident in my body, in my strength and in my capabilities. I actually feel so blessed to have been a labor and delivery nurse for so many years before I have children. I am well educated and well informed about my choices. I have seen powerful births, and tragic births. And through all I have seen I have learned so much. I truly understand how my mindset, my choices and the people I choose to surround myself with when my time comes to give birth can impact how my birth plays out. I am not denying the potential for an outcome I would love to avoid, or the potential need for medical interventions. But I know what I need to do and what I need to avoid to put myself in the best possible position for an outcome that will make me proud to be a woman and confident in my capability to be a awesome mom. I will not let the nurses who believe in the “The curse of the nurse” destroy my dream of an empowering birth. We have the power to create magic with our words, I choose to surround myself with people who want to bless me not ones who wish to put a curse on me.
4) As a nurse with dreams of becoming a midwife. When one has been called to something in life, you can only ignore that calling for so long. I too feel that pull to empower women and touch their lives in an even deeper and more meaningful way. As an LD nurse we often meet women for the first time when they walk in the door in active labor, and after they deliver, we may never see them again. We don’t know if they felt empowered or deeply wounded by their birth experience. I dream of working with women throughout pregnancy, birth and postpartum to help guide them to experience birth as the wonderful, life changing right of passage that it can be. The time is not right now. So I will give what I can and continue to pour love into my current role in birth, but not let go of that dream that someday I will be a midwife too.
Thank you NursingBirth for inspiring me to write about my experiences with birth and providing the forum for sharing my love of the work that I do.
What an amazing and empowering story to watch on so many levels! I am inspired by Lindsey’s story in many ways:
First, as a woman who has yet to have any children. After watching this video I am left with feelings of awe, reverence, and respect for what we as women are capable of! I can’t help but be excited about my own potential as someone able (I hope of course) to conceive, grow, nurture, birth, and nourish a new life! (I am giving myself goose bumps just thinking about it!!)
Second, as a labor and delivery nurse. Watching this video reminds me not only of what consumers of maternity care are capable of but also of how much of a difference each one of us can make just by changing our own attitude, educating our own minds, and stacking the cards in our favor to help shape our own experiences! (Now I’m going to be humming Michael Jackson’s Man in the Mirror for the rest of the day: “If you wanna make the world a better place, take a look at yourself, and then make a change! Na Na Na, Na Na Na, Na Na, Na Nah!” J) And as a labor and delivery nurse I hope to help as much as I can help by strategically, respectfully, and appropriately planting little “seeds” of encouragement, knowledge, and know-how in the minds of the many women I am fortunate enough to meet in my personal and professional life.
Third as a labor and delivery nurse who has yet to have children!! Lindsey wrote, “As the years pass and [my daughter] grows I soon find myself sending my baby off to kindergarten! Fighting off the urges to have another baby over the years because of the intense fear I have of having the same birth experience again. I know that its time and I must face my fears head on! All of my training and experience with over 175+ births has surely had to of taught me something! Without looking back I take a leap of faith and trust my body will work!”
I hear nurses I work with all the time say “Oh I am so glad I had my children before I started working here! I would have been a nervous wreck if I was in your position!” My first thought it always “Umm yeah thanks, that isn’t very comforting.” But I also know that I am so very fortunate to have worked where I work before having kids. I think about how much I didn’t know before I started and how I very easily could have been a victim of situations like these. However, as much as I know in my heart that I want to take that leap of faith and trust my body will work as I have seen it so many times before, even labor and delivery nurses like me have that little voice of doubt in the back of their minds. You know the one that says “But can I really do it?” So reading stories like Lindsey’s where even a midwife has that little voice is very reassuring to me that a certain amount of worrying and doubt is totally normal and doesn’t mean that I will fall victim to the old adage “Oh she’s a nurse? Set up the back for a cesarean!”
Forth, as a nurse with aspirations of becoming a midwife. Lindsey wrote, “I knew at the deepest level of my being that I had to help women, educate women” and I have to say, when I have the privilege of being part of an incredibly empowering birth experience I can’t help but think to myself, “I have to be a midwife! I just have too!” Likewise, when I find myself in one hell of a mess at work (especially if a midwifery model of care and the Six Healthy Birth Practices that Support Normal Birth are not followed for any other reason besides true medical necessity) I also think to myself, “I have to be a midwife! I just have too!”
I hope you enjoyed this video as much as I did. Stay tuned for next time as I have been excited to tell you all about an absolutely amazing birth I was lucky enough to be a part of where I had My First Catch.
I came across your blog and I thought you might be interested in seeing the images from the recent home birth I photographed. I am a professional photographer, mostly I do portraiture work with mothers and newborns but occasionally I photograph birth. I love the change of pace and the adrenaline rush : ) I am also a natural birth advocate and gave birth to my son at with a midwife at a free standing birth center. We are planning to have our next baby at home. The popularity of birth photography has increased dramatically over the last year – I think signaling a shift in how we think about birth.
There is a slideshow with all the photos set to music linked at the bottom of the page. Just scroll down and click the link that says >>The Birth of Waldron Dain Peterson<<. Take care and happy blogging!
Your pictures are gorgeous!!! Makes me want to move to Seattle and have a baby!! Good luck with your home birth plans and have fun trying for #2!!! Thank you for the link to your website as I know many of my readers love to read other women’s empowering birth stories and while a photo slideshow isn’t technically a birth story, a picture is worth a thousand words!!
While watching Waldron’s birthday slideshow I was so overcome with positive emotions like happiness, awe, empowerment, and especially a deep respect for our strength and abilities as women! Some of my favorite pictures include: (1) The one where the mother is bending over in the hallway, her husband is bracing her and her sister is rubbing her back. I love how you can see the “family picture” in the background because you know that in just a short while they will have a new addition to the family!!, (2) The one where the mother is bending at her waist and then looks up with a smile. She is either in transition or pushing but she still has a smile on her face, knowing what all of this hard work is for!!, (3) The “Moment” Shot where mom holds her baby for the first time and looks up at her husband with a face that says “I DID IT!” and “I LOVE YOU!”, (4) When “big sister” leans over the tub and is looking up like “Is that my brother!?!”, and finally (5) The whole family sitting on the bed together, happy and healthy!!
“The birth of a child is one of the most significant and beautiful events in life. I am always honored when I am invited by families into these very intimate moments to document their memories. The first moments of life are so precious…the first breath, the first cry, the first time your baby looks into your eyes. I love documenting these moments for my clients and I know that they will treasure them forever. The birth of a child is one of the biggest defining moments in your life and you will not regret having it photographed. Printed images are stronger than memory can ever be and you will be so thankful that you have them to hold onto for your children, your grandchildren, and their children.”
In the blog section of her website, photographer Emily Weaver Brown’s writes about why she loves photographing births, how she met her client Jessica, and why Jessica chose a home birth. Check out her original post for more information about how Jessica’s labor went!
“I loved photographing this birth for many reasons. It’s so difficult to be just an observer, and though I strive to photograph the birth as though I wasn’t even in the room I still get pulled in. Before a birth I meet with my client’s to discuss their wishes and get to know them. (I don’t want to be a complete stranger showing up one of life’s most intimate and raw experiences.) This meeting and the subsequent emails usually leads to friendship and before long I know all about their previous birth stories and all of their hopes and dreams for the birth that I will photograph. So I can’t help but cheer on the moms while they work hard to birth their babies. With Jessica it was no different. Jessica is actually a former client of mine who is now also a professional photographer. I know that she really values photography as an art form and that having the birth of her second child documented in photographs was really important to her. But even more than that, I knew that the birth of Jessica’s oldest child did not go as she had hoped. She ended up with a healthy baby girl but also a lot of interventions that she didn’t want and it made her feel like she had failed. I had no doubt in my mind that Jessica would be able to birth her second baby at home naturally as she had planed but I so wanted it to go perfectly for her so that she would have a sense of redemption over all that happened during the birth of her daughter.”
Please visit http://emilyweaverbrownphoto.com/blog/birth-photography/ and scroll down to the bottom of the page to see two more birth photography slideshows, both of which are hospital births. Just curious, did any of you feel differently when watching the home birth slideshow vs. the hospital birth slide shows?? Why?
The other day I stumbled upon a YouTube video advertisement for a midwife in Albuquerque, New Mexico via a friend’s facebook page. You’d think that I must get sick of watching videos of births and babies since I am, after all, a labor and delivery nurse but alas, I am a true birth junkie and just can’t get enough!! I don’t know anything about the midwife in the movie but I have to say that not only do I BELIEVE everything she quotes in the video but I wish that every health care professional that provides care for childbearing familes felt and practiced the same way as she does!
I believe that every mother DESERVES a midwife and that every baby DESERVES to be born into gentle hands!
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.
I wanted to share with you my birth story. I thought since I did an all natural VBAC, it might be something you would want to share. Thanks for the posts. YOUR blog helped me get though my second birth! Your stories of inspiration that you have are amazing, and just your general tone. The fact that there are nurses out there like you made me have the confidence to trust the nurse with me, but also not be totally trustworthy. It helped me realize that I am the final decision maker.
In preparing for my VBAC I read your Injustice in Maternity Care Series and your story “I Needed to Know My Body Could Do It!”: A VBAC Story over and over. I also read Active Birth by Janet Balaskas which I think helped me a lot, and with our first daughter (my c-section) we took Bradley classes so we both thought we were so prepared. This time I had my mom, a friend and my husband as my birth team and we took control, which reading about it from your point of view gave me the courage to do so!!!
I would LOVE to reprint it and am honored that you would even send it to me! Thank you for reading and THANK YOU for being such an awesome and empowered woman and mother!! It is women like you that are an inspiration to ME!
I just love everything about your birth story!! First off, CONGRATULATIONS on your VBAC and on the birth of your daughter!! What a wonderful time for you and your family! It also must be really nice to NOT have to recover from major abdominal surgery and take care of a newborn and 3 year old! Second, one HUGE pat on the back to you for choosing to go back home during your initial trip to the hospital when you were found to be 2 centimeters. That took A LOT of courage and trust in your body and your abilities, especially since the on-call doctor was pressuring you to stay. And I completely agree with you; choosing to labor at home until you were more “active” most definitely had a significant impact on your successful unmedicated VBAC. Thirdly, KUDOS to you for being an active participant in your birth!! It no doubt helped your labor progress to be upright and moving during your labor! I am so proud of you!! While it’s true that no one can really “plan” their birth, you did everything you absolutely could to stack the cards in your favor!! Yay! Yay! Yay!!!
Starting on Friday, May 22, I started having very mild but consistent contractions at 5 minutes apart at lunch time. The rest of the day they came and went, some getting farther apart but stronger slowly as the day went on. I also had a lot of brownish and pinkish spotting. Figured that maybe I was in very early labor. Did my usually stuff that day and went to bed about 9:00pm, just in case this was it. Saturday morning I woke up about 1:00am with contractions strong enough that I couldn’t sleep. I got up and ate some peanut butter toast and drank a bunch of water and tried to go back to sleep. Contractions were about 7 minutes apart but stronger and enough so that I was having a hard time sleeping. Likely because I was excited. Got up and took a bath but that didn’t help. Tried to go back to sleep. Got up and ate 2 huge bowls of apple cinnamon cheerios. Finally fell back asleep about 4:30 am. Woke up at 7am and was just very tired. Contractions were completely bearable but figured that we were starting (maybe) and so I had Madison go to Jaxson’s (and George and Amie) house for a few hours while my mom and I stayed home to see if anything would progress.
Lamaze International's Tips for a Normal Birth #5: Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.
As the day went on they got stronger but not really closer. I called L&D and she said 3-5 minutes apart, not able to talk through them, so I just figured I would wait. Wasn’t ready to go to the hospital yet anyway. I called Meredith (a friend), who was working about 2 hours away, to let her know that she might have to come back that night. We decided that she would come back that night instead of waiting for a call at 2:00 am and have to drive then.
Lamaze International's Tips for a Normal Birth #6: Think carefully about who you want to give you support during labor and birth. Consider hiring a doula or other professional labor support person to give you, your partner, and any other support person who's with you, continuous emotional and physical support.
My back started hurting and I called another friend of mine who does massage. She wanted me to come to her studio, but I really didn’t want to leave the house, so I decided to stay home. Rob called his mom and went to meet her and take Madison to her house so that we wouldn’t have here with us. By the time Rob got back, about 6:30pm, contractions were 5 minutes apart and getting stronger. I could still talk and walk, but it took effort. I called Meredith back and she said she was on her way to my house. At 7:30pm I started to panic. The contractions seemed very strong to me, I was concentrating on them and they were consistently 5 minutes apart, so we decided to head to the hospital. I called Meredith and told her to meet us there. Once I got there, my contractions stopped pretty much, likely due to my nerves. They got me into a room and set and checked me and I was 2cm and 80% effaced. I was devastated! I told them I wanted to go home. The doctor on call was leery of that since I was a VBAC and they said they would really like me to stay but I refused and we packed up and came home. (In hind site, this was the reason it all worked out!! Best Decision!!!)
I went to bed disappointed and tired, since I had been contracting for nearly 30 hours at this point and I just wanted to either be in labor or not. I ate a snack and went to bed. At about 3:00am I was woken by very strong contractions, 7 minutes apart, strong enough that I would flip to hands and knees in bed and rock and moan through them. Rob decided I was in labor, though I was still not sure! LOL! I started just sleeping in between them. (Must have been some natural coping mechanism, since I did it until about 6:30 am!) We started timing for real at 7:00am. Meredith came over and she helped my mom. My mom would time the start to start and Meredith would time the duration. They were about 5 minutes apart with about 30 seconds of what I would call pain. The actual contraction would last about a min or longer.
As the morning went on, I could no longer do anything during the contractions except hang onto Rob and moan. Contractions got stronger and longer. They were 4-5 minutes apart, and lasting (pain) about 70 seconds. During one contraction while I was hanging on to Rob I had a huge rushing feeling, almost like a pushing sensation (or so I thought) so I just said, “We have to go NOW!” We packed up and went up to the hospital. I had 4 contractions in the car, which were the hardest ones! [At that point I preferred to be standing during them, since sitting or lying down was excruciating.] We got back to the hospital and I was moaning and hanging on Rob and everyone in the ER was looking at me funny. It made me laugh. They probably all thought I was crazy!
I went back up to L&D and they put me in the same room and got me all set up again. The nurse said, “We were waiting for you!” I was so nervous that I would only be 3 centimeters and they wouldn’t let me go! She checked me (about 11:00am) and I was 6cm, fully effaced!!! I cried when she told me, I was so happy!! Rob, Mom and Meredith clapped! LOL! They told me I had to stay. I said that was fine! They put me on the monitors and said I would be able to get off of them, but then the Dr. on call said “NO!” so I was worried I would be stuck in bed. The nurse said, “You can move as much as you want, so long as the cord is long enough,” so I got out of bed and stood next to it for most of the day. We said I didn’t want to be checked again except by the doctor or if they thought I was complete (i.e. pushing) so when the doctor got there at 1:00pm she checked me and I was a stretch 8!! I was still concerned that it wasn’t going to happen, but everyone else was excited.
Lamaze International's Tip #4 for a Normal Birth: Plan to move around freely during labor. You'll be more comfortable, your labor will progress more quickly, and your baby will move through the birth canal more easily if you stay upright and respond to the pain of your labor by changing positions. Try rocking, straddling a chair, lunging, walking and slow dancing.
Transition for me was the second hardest thing I have ever done. I refused pitocin (which they really didn’t push since I was a VBAC) and did not let them break my water. I stayed at a 9 centimeters for almost 3 hours, then at 9 ½ centimeters for a while until I begged them to stretch my cervix!! LOL! I was on the bed with the back raised on my hands and knees and suddenly had a contraction that felt better when I kinda of pushed at it. My mom went to get the nurse and she tried to check me like that but said I really needed to lie down. I said I didn’t want to push lying down and she said, “Sweetie you can push however you want, but I need to make darn sure you are complete so you don’t swell.” I knew that was true so I got down and she checked me and then had the doctor come in and doctor said, “I’d call that complete!”I was so freaking happy! However I was also exhausted and once I was lying down, though I was hurting, I just couldn’t get back up again. They broke my water sometime in there. [I think it was earlier when I was at a 9 ½ centimeters but I can’t remember.]
The first few pushes I really thought I was doing it but I think the contractions were just not strong enough. I actually asked the doctor how far down Hana had to be to use the vacuum! I was exhausted! The doctor said that she wasn’t going to use the vacuum, so I was just going to have to push! I started pushing about 4:45 pm. She would come down (once I finally figured out just how freaking hard you have to push!!) and then scoot back in. They explained to me that a little bit of pitocin would help to bring the contractions a little closer together, so I would be more effective in pushing, since I was having over a minute between them and Hana would just scoot back in. I finally agreed to it at about 5:45pm. The started it at about 6pm. The doctor suggested a pudendal block, in case I needed an episiotomy (which while I wanted a natural tear, I wasn’t against at that point and I never thought I would come through it with no tear or cut). I even got a mirror to see my progress, and knew right then that something was going to have to give! I made them put the mirror away!
I started pushing 5-6 times per contraction and the doctor had been with me the whole time. She had them break the bed and get all the stuff ready and I asked “Is she coming out this way?” and the doctor laughed and said, “I’m not doing a c-section today!” She asked me also if I wanted to feel Hana’s head, but I just couldn’t bear the thought for some reason. I kept pushing and finally she said, “Ok, this next one you’re going to have your baby!” and so I hauled back and pushed harder than I thought possible and her head popped out and I kept pushing (oops!!) and Hana was born Sunday May 24th at 6:28pm!!! It was the most amazing thing in my life and no doubt pushing was the hardest thing in the world.
Lamaze International's Tips for a Normal Birth #10: Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping the baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.
They gave her to me and after a few minutes (she was breathing but a little blue still) they took her over to rub her and clean her up some. I was shaking so bad at that point that Rob had to hold her. I ended up with a 4th degree tear… not from her head, but her shoulder popped out when I pushed and the doctor wasn’t expecting it, and so that’s that. But it isn’t so bad! She stitched me up, and while it is sore, it beats the hell out of a c-section! Right after she was born I said, “I had a baby out of my vagina!” much to the amusement of the nurses and pretty much everyone in the room! But I can’t tell you just how amazing it was for me. I had been waiting 3 years for that. And now I have it! Hana was given back to me and she latched on right away and nursed like a champ for 15 minutes on each side (I was STILL being sewn up!) and finally Rob and Hana went off to the nursery. To our surprise (and the doctor’s too) she was 8lbs 1 oz, 19 inches long.
Happy Birthday Hana!!!!
I am recovering very well and almost feel like new!!
For more information on Vaginal Birth After Cesarean (VBAC) check out the International Cesarean Awareness Network's website at http://www.ican-online.org/
Today I read an article on www.journalgazette.net, the website for the newspaper The Journal Gazette based out of Fort Wayne, Indiana that really gave me the warm and fuzzies.
The article is entitled For some, life begins at homeby Emma Downs and it tells the story of a local family that researched, planned, and ultimately had a positive and empowering home birth after a dis-empowering hospital birth with many interventions. The article also touches on the growing demand for home births that some midwives are reporting in many communities and how for families that chose home birth, it is about personal responsibility and research and most importantly, informed choice. I really liked this article as opposed to other articles I have read on home birth in other major media outlets because it just tells it like it is without over-sensationalizing it. A GREAT read!
Last week I had the honor to be a part of one of the most beautiful VBAC (Vaginal Birth After Cesarean) hospital births I have ever witnessed.I would like to share that couple’s story with you today as both a feel-good tale of personal triumph and a story of inspiration for all those moms planning a VBAC out there that might stumble upon my blog.Since this is a blog about “a nurse’s view from the inside” this story is probably much different than any other birth story you might have read from the mother or father’s point of view.But then again, maybe that isn’t so bad!Enjoy!
It was ten to 11 o’clock am as I walked through the lobby doors of the hospital I work at, rushing towards the elevator so I could punch in on time.As the elevator doors started to close, a hand shoved through the crack, forcing the doors back open.“Please make room!” said the woman, a phlebotomist who works in the hospital, in a shaky voice, “Woman in labor here!!”Following behind was a very pregnant woman, huffing and puffing as she waddled into the elevator, followed by what looked like her husband and her mother.“Don’t touch any buttons!” said the phlebotomist, “We’re going right up to labor & delivery!”Since that was where I was headed too, I smiled at the husband and said, “Don’t worry, you’re here now and she won’t have the baby in your car!I work up on L&D so I’ll show you were to register.”Something told me that if this woman was truly in labor then she would be assigned to me since I was just starting my shift. But she had to “pass” triage first, so after helping the family to the registration desk, I hurried into the locker room to change into my scrubs.
Fifteen minutes later the triage nurse came to the main desk, “I’ve got a term mom, 40 weeks 5 days, who’s five centimeters,” she said, “We’re gonna need to put her in a room….And she’s a VBAC with a ‘birth plan’.”“I’ll take her!,”I said excitingly, knowing that I have my best days when I can assist a woman through labor, as opposed to getting stuck on the OR team or in the high risk ward running magnesium.(Not that those women don’t need a lot of TLC too, it’s just that I like labor the most!)Birth plans, natural unmedicated labor, and getting my patients out of bed…those are my specialties!I quickly set up the room across the hall as the resident finished the patient’s history and physical in the triage room.Then I quietly knocked on the triage room door and let myself in.The patient, Alyssa*, was standing by the bed, rocking her hips back and forth, as the continuous monitors strapped to her abdomen traced the baby’s heart rate and her contraction pattern.It looked like she was contracting every 3 minutes, and the baby’s heart rate was beautiful and reassuring.Her husband, Jared, was leaning nervously against the wall and her mom, Deb, was sitting quietly in the corner.I could really tell that Alyssa was lost in “Laborland” and I wanted to make the transition to her room as seamless as possible as to not break her rhythm and concentration too much.I quietly introduced myself and with the help of Jared and Deb, moved all of their belongings across the hall as Alyssa waddled behind.
I could tell that Alyssa was coping well with the contractions while standing but a quick glance at her prenatal summary revealed that she was Group B Strep positive and would need IV antibiotics (our hospital’s policy) and hence, and IV.Now I feel that I am pretty skilled at starting IVs, but I have not yet mastered starting an IV with the patient standing and swaying!So in the two minutes between the contractions, I explained to the Alyssa what I needed to do before the admission process was complete: get 5 more minutes of continuous monitoring on the baby (to equal the “20 minute strip” my hospital’s policy requires before we can switch to intermittent auscultation), take a set of vital signs, draw three tubes of blood, start an IV, and ask a few more questions.“Give me 8 minutes sitting on the bed,” I said, “and I can have everything but the interview done.The rest of the admission can be done with you standing up.”“Okay,” she said, “I can do eight minutes.”Eight minutes later the IV was in, antibiotic running, labs drawn and sent, vital signs done, monitors were removed, and the patient was helped out of bed (Phew!!That was close!! J).And it wasn’t a moment too soon because Alyssa was having a lot of back labor and sitting in bed was just making it worse!
Then there was a knock at the door.Here’s how the subsequent conversation went down…
Me:“Who is it?”
Med Student: “It’s just the medical student,” (said as he walked right into the room)
(I hadn’t yet gotten a chance to ask Alyssa if she was okay with medical students so I just kind of looked over at her and Jared and tried to judge their reaction.)
Med Student:“Hi I’m Michael.I have to ask you a few questions.”
(Have?How about “Is it okay if I ask you a few questions?Sheesh!!)
Med Student: “Are you being induced today?” (asked as he stared down at his paper)
Alyssa: “INDUCED!DOES IT LOOK LIKE I AM BEING INDUCED!”
Med Student: “Okaaaaay.Umm, any problems with this pregnancy?”
Jared: “Do you really need to ask these questions right now?The resident already asked her that stuff.”
Med Student:“Umm yeaaaah, I do.There is a lot of repetition but we have to ask again.”
Deb: “Doesn’t her prenatal summary tell you all of that?
Med Student: “Ummmmm….”
Me: “With all do respect, Michael.But I think they are trying to tell you that they do not want any medical students.Or anymore residents for that matter.Okay?So I think we are done here.”
Med Student: “Ummm, what am I supposed to tell the resident?”
Me: “Tell her I said that the next induction that comes in is all yours.”
As the med student left, Jared, Deb, and Alyssa all looked at me simultaneously and said “THANK YOU!”“I don’t think he was getting the hint,” said Jared.“Yeah,” I said, “I figured he needed it spelled out.”In hind sight, I think this was one of the moments that really helped me to bond with this family because after all, I understand how difficult it must be for families to come into the hospital and have to work with a nurse that they have even never met during one of the most intimate experiences of their lives!
I spent the next fifteen minutes finishing up the patient’s admission assessment as quickly as I could.I told Alyssa that if she was having a contraction to just ignore me, and asked Jared to help answer any questions he knew the answers to.(Unfortunately, our hospital’s pre-registration does not include performing an admission assessment and hence, it has to be done on arrival to the hospital.Usually, if a patient comes in for false/early labor a time or two, it gets done then but Alyssa had not been to the hospital her whole pregnancy, which is great, but it meant that I did have to bother her with some silly questions during labor.Kind of a bummer, but with the help of Jared, it went pretty smoothly.)It was during the admission interview that I found out some of the details of Alyssa’s pregnancy and prior cesarean section.Alyssa had an unremarkable health history and a normal, healthy, uncomplicated pregnancy.She was a G2P1, but since her first baby was born by cesarean section, she technically was considered to be a “primip” (healthcare slang a woman who is about to deliver her first baby) regarding a vaginal delivery.
Jared told me that when their son was born two years ago, Alyssa was persuaded into an induction at 39 weeks for “LGA” (a.k.a. large for gestational age, which by the way is NOT recognized as an appropriate indication for induction of labor by ACOG), was first given a few doses of misoprostol to “ripen” the cervix, followed by pitocin to stimulate contractions and continuous external fetal monitoring to monitor those contractions, then given a couple doses of Stadol and eventually an epidural for the pain, followed by artificial rupture of membranes to place a fetal scalp electrode after the epidural dropped Alyssa’s blood pressure and caused a prolonged fetal heart rate (FHR) deceleration, then an intrauterine pressure catheter to assess if the pitocin induced contractions were “adequate”, and eventually a cesarean section after 1 hour of pushing in a back-lying position for “failure to descent & cephalopelvic disproportion (CPD).” Thirty minutes later baby Kevin was born at approximately 2:00am, weighing in at 7lbs, 5 oz.
In my opinion, Alyssa was a victim of the “cascade of interventions.”Many maternity interventions, including elective induction, pain medication, artificial rupture of membranes, epidural anesthesia, back-lying positions for labor or for birth, etc. have unintended effects. Often these effects are new problems that are “solved” with further intervention causing a domino effect that ends up creating yet more problems. This chain of events has been called the “cascade of intervention” and unfortunately often leads to vacuum extraction/ forceps delivery, episiotomies or 3rd or 4th degree tears, and even cesarean section.Many of these women are often also then mislabeled with diagnoses like “CPD,” “failure to progress,” “failure to descent,” and at the end of it all, the obstetricians turn around and say, “Thank God we were in a hospital; look at all the technology we needed!So when will your repeat cesarean be??”
This time, however, things were different.After the birth of their son, Alyssa and Jared started to research more about labor and birth, VBAC, and natural birth.They interviewed and chose a doctor (Dr. Z) that was supportive of natural birth and VBACs, with the statistics to prove it!And here they were now, at my hospital, ready and rearing to go!Alyssa said that for the past few days she had been having contractions “on and off” but that they really started to get going at 8:00 am.When the resident had checked her on admission, her water spontaneously broke during the vaginal exam at 11:15am.It was now 11:45am and Dr. Z’s midwife entered the room.Although it had only been 30 minutes since her last vaginal exam, the midwife decided she would check Alyssa again since she seemed pretty active.And boy was she ever!The midwife’s exam showed that Alyssa had progressed to 7-8 centimeters!“I don’t think I can do this anymore,” Alyssa softly whimpered to the midwife.We all reassured her that she was doing so well and that things were getting more intense for a reason and to stick with it!!
The midwife then offered to help Alyssa into the shower to help alleviate her back pain.Alyssa seemed skeptical at first but we assured her that if it wasn’t helping, that we could get her right back out.So Alyssa agreed and the midwife and I, along with Jared, helped the patient into the shower.What happened for the next hour was one of the most beautiful displays of love, perseverance, hard work, and dedication I have ever witnessed.Alyssa turned her back to us and rested her hands on the grab bar on the shower and her head on the shower wall.Her cadence was this: Between contractions she would sway side to side, as if she was slow dancing.During contractions she would squat up and down, up and down, moaning in a low tone as she carried out her ritual.She just moved with the rhythm of her labor, listening so instinctively to what her baby and her body were telling her to do.Jared used the hand held shower head to spray Alyssa gently with a stream of warm water up and down her body, concentrating mostly on her lower back. I quietly entered the bathroom a few times that hour to check the baby’s heart rate with the portable doptone, trying hard not to disturb Alyssa’s concentration.Mostly, however, the midwife, her mother, and I stayed outside the bathroom door as to give Alyssa & Jared the privacy they needed to facilitate the progress of her labor.
At 12:35pm Alyssa told me that she was starting to feel a strong urge to push.The midwife entered the room and as Alyssa knelt in a hands and knees position in the tub, the midwife checked her cervix.To everyone’s surprise Alyssa only had an anterior lip of cervix left to go (this means she was about 9 ½ centimeters dilated)!After the next contraction, Jared and I helped Alyssa out of the shower to the toilet where we both used warm towels to dry her off.Then Alyssa walked over to the bed, “Can I kneel on my hands and knees?” she asked.“Sure!” we all said in unison, as we helped her up onto the bed.“I feel like I have to push!” Alyssa said convincingly and when the midwife checked her cervix, the anterior lip was gone…Alyssa was fully dilated at 12:45pm, only 1 hour and 55 minutes after arriving at the hospital!“You can start to push anytime,” said the midwife.
One of the best things about being a part of this experience was the fact that it was one of the only times that I have been present at a delivery where that a birth attendant has allowed the mother to use spontaneous or mother-directed pushing, as opposed to directed pushing.I knew that Alyssa was interested in using a variety of pushing positions for the second stage of labor from her birth plan and for the next hour and a half the midwife, Jared, Deb, and I helped Alyssa get into a variety of positions including right/left side lying, squatting, hands and knees, and kneeling.
(Side Note: I would like to digress for a moment to point out how important it is to be physically fit during your pregnancy whether you are planning for a natural birth or not.Many a woman I take care of blindly fills out a “birth plan” they find online where they can click on the boxes for options that sound “good” to them, without actually researching or thinking over what they are writing down.For example, they say that they want to try squatting during labor and birth, but couldn’t even do a squat at the gym pre-pregnancy.Although it is definitely true that a woman can sum up and realize an incredible amount of strength during labor and birth related to not only hormones but also sheer will power, it should also be known that labor is HARD WORK and pushing out a baby is HARD WORK which both require a great deal of physical strength and stamina.This is yet another reason why it is so important to follow a modified exercise plan and eat a healthy well balanced diet rich in protein and omega-3 fatty acids before, during, and even after your pregnancy.)Let’s continue with Alyssa’s story…
What was so amazing was that although there were plenty of times during the labor and pushing phase that Alyssa would doubt her ability to go on (“I can’t do this anymore!”“The baby isn’t moving?”“Is the baby moving?”“I am so tired!”), she never gave up on herself.Each time she made a comment like that, we all took it as a request for more support.And every time we gave her more encouragement, cheers, and reminders of her progress and goals, (“Keep going!”, “You are doing so well!”, “We can see so much more of the baby’s head!”,“She has lots of hair!”,“Just a few pushes more”,“You are so strong, you are going to do this!”, “You can do this!”), she found the ability to keep going!Towards the end of the pushing stage Alyssa was (understandably) exhausted and was pushing in a modified lithotomy position while Jared and I supported both of her legs.Then all of a sudden Alyssa popped up and said (and I quote) “I need GRAVITY!I need to be UP!” as she sat upright into a full squat and pushed her baby’s head out with one gigantic roar!“Whoa, whoa!” the midwife and I said almost simultaneously, “Easy, easy, baby pushes.”“Blow like you are blowing out birthday candles,” I said.The midwife checked for a cord around the neck (which there was none) and cleared the baby’s mouth and nose.And with only a few more “baby pushes” Addison Joy was born at 2:27pm!
The room erupted into cheers of excitement and tears of happiness J! I put the baby skin to skin on mom as I dried her off with warm blankets and cleared her mouth and nose with the bulb suction.A quick palpation of the baby’s cord revealed that her heart rate was nice and strong and she was pinking right up! Jared and Alyssa kept hugging and kissing each other and talking to their new baby girl, “Hi Addison!Hi baby girl!I am so glad to finally meet you!”The midwife waited until the cord stopped pulsating before she cut it (per mom and dad’s birth plan) and checked Alyssa for any tears.Except for some swelling, she only had a small tear on her right labia that didn’t even require any stitches!!We kept mom and baby skin to skin for a full hour after birth and baby Addison nursed almost the whole time.When she was an hour old, I weighed her to satisfy mom’s curiosity and to everyone’s surprise the baby weighed 9 lbs 3 ozs!!!So much for “cephalopelvic disproportion” huh!!
And it was as I handed baby Addison back to Alyssa that she looked up at me and said softly, “I needed to know my body could do it.I knew my body could do it!I really needed this.Thank you.”So as you can imagine, I started to well up.I have never felt so honored to be a part of something so special.What a privilege to have a job where I witness the miracle of birth and the miracle of motherhood every week!
So let’s recap shall we.Alyssa, after having a cesarean section for her 7 lb 5oz son two years earlier for “CPD” and “failure to descent”, pushed out a 9lb 3oz baby after a 6 hour and 27 minute labor, including 1 hour and 42 minute of mother-directed pushing, without any pain medications or an epidural, monitored by intermittent auscultation, needing not a single stitch to her perineum!Her tools included good and relevant labor & birth preparation, appropriate and helpful family support, sheer strength, determination, and will power.The midwife’s arsenal included extensive knowledge of and experience with natural birth and labor support, a doptone, a trust in birth, and a belief in Alyssa’s ability to do it!No medications, no vacuums, no scalpels, no scissors, and no doubt!
I recently was sent a link to a website that lets you watch the 2008 documentary entitled Pregnant in America: A Nation’s Miscarriage for free.The catch is that it will only let you watch 72 minutes of the movie, and then it makes you wait an hour to watch the rest (unless you sign up for their program which costs money). So if you don’t mind watching half the movie before dinner and then the other half after dinner, it’s worth it to just wait watch it for free!
The synopsis posted on the documentary’s website reads:
“Pregnant in America is a motivational and inspirational documentary made by film maker Steve Buonagurio about the birth of his daughter Bella. Shocked by the greed of U.S. hospitals, insurance companies and medical organizations, Steve and his wife Mandy set out to create a natural home birth in a world where everything is anything but natural. The film is as much educational as it is entertaining and prepares excepting parent for their uncertain journey of being pregnant and having their baby.”
My overall impression of the movie was good, as it is very empowering to see “ordinary” people (that is, couples who are not already in the birth advocacy community) honestly researching all their options once they become pregnant as opposed to buying into the medicalized culture of fear that so many of us grew up to believe is the only way.I have been meaning to watch the movie a second time so that I may give it a more thorough review but just haven’t found the time.Check back soon for an update!
My only criticism of the movie is that it seems a bit scatterbrained and “all over the place” at times and when I finished watching the movie, part of me felt like there was no real cohesive message but instead, a bunch of scattered messages throughout.Other than that I feel it is a documentary worth watching.I am also interested in hearing all of your impressions too J!What do you think?!
Nursing Birth 
Super Comment! Unexpected Guest Post from a Mother-Friendly L&D Nurse October 14, 2009
Tags: birth stories, labor and delivery nurse, midwife, natural birth
A couple days ago I posted this: One Woman’s Journey To Her Own HBAC Water Birth and 360 Degree Career Change
Like always, I woke up this morning and sat down in front of my computer with my bowl of Cheerios to check the comments left on my blog. I was pleased to see that I had a few comments about that post. One in particular however, actually brought me to tears. I was especially moved by her “garden” metaphor. (I know, I am such a sap!)
Alethea is from Colorado and has been working with birthing families as a labor and delivery nurse for the past 8 years. When she comments on my blog, she often writes about how she is truly inspired and amazed by the power of birthing mothers. She became a trained BIRTHING FROM WITHIN® mentor out of her desire to help guide more women along the path of empowerment through their birth experiences. Alethea is also a co-founder of Colorado Conscious Birthing.
I think I was so moved by Alethea’s comment because I feel the same way about being an L&D nurse as she does. Witnessing the miracle of life, the power, strength, and determination of women, and the overwhelming love of family and friends as your job is pretty amazing. And I love it. Even when I am having the worst day imaginable, I still love it.
So I just couldn’t let this comment die, hidden away for only a few stragglers to read as they come across the old blog post. I hope you enjoy it as much as I did! It really brightened my day!!
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Dear NursingBirth,
This post spoke to me in ways that I can not express in written word, but I will try. I also am all four of these women you write about.
1) As a woman who has yet to give birth. The power of a woman giving birth the way nature intended (regardless of the setting) takes my breathe away every time. This was a beautiful, inspiring, empowering montage. I hope to some day be empowered by my own strength and beautiful birth.
2) As a labor and delivery nurse. My inspirational theme song is Ben Harper’s With my own two hands:
…”I can change the world, with my own two hands. Make a better place, with my own two hands…make a kinder place….I can make peace on earth…I can reach out to you….gonna make it a brighter place, gonna make it a safer place, gonna help the human race… with my own two hands…I can hold you…I can comfort you…but you got to use, use your own two hands…”
Empowering women to search inside themselves and tap into their deep well of intuitive knowledge and strength is what keeps me coming back for more despite how tired, burned out, and sick of the politics I might be. Forgetting the hustle and bustle outside in the hallways, my job is to delicately plant the seed that they can do this, they are strong, they are capable. Bearing witness to the strength and power that women are capable of is an honor. I am an advocate of normal birth, an advocate of women, an advocate babies and daddies and doulas and new families. I am a labor and delivery nurse because I love supporting women with my own two hands, occasionally being lucky enough to be the first human to hold new life in my own two hands, but especially helping to break the cycle of doubt and fear in order to inspire women to understand that they can birth with their own two hands (or on their own two hands and knees).
3) As a labor and delivery nurse who has yet to experience birth. It seems to me that because Lindsey is a home birth midwife she had the distinct advantage of seeing mostly normal, natural, beautiful births to inspire her. And yet she still had that little seed of doubt threatening to take over her mind. Like a weed in a garden, we have to pull up those seeds of doubt so they don’t take over our beautiful gardens. We must lovingly attend to our gardens (growing baby, growing minds) nurturing the beauty, inspiration and trust. Sometimes we pull up a weed, but we don’t get the entire root, and it comes back, even stronger and with a vengeance. Threatening all the beauty and strength we have worked so hard to grow. Pregnant and birthing women need to surround themselves with people who want to help tend to the garden, and avoid people whose defeatist attitudes are apparent in their neglected gardens (minds, attitudes) full of weeds (doubt).
Working in the hospital we do see a lot of “failure”. Failure to progress, arrest of decent, fetal growth restriction etc, etc, etc. The weeds (negative thoughts) in the hospital birth culture are rampant. It takes even more hard work and dedication for those of us immersed in it to remember that the majority of birth could be normal and natural and beautiful if we nurtured and support physiologic birth and weeded out unnecessary intervention. I am confident in my body, in my strength and in my capabilities. I actually feel so blessed to have been a labor and delivery nurse for so many years before I have children. I am well educated and well informed about my choices. I have seen powerful births, and tragic births. And through all I have seen I have learned so much. I truly understand how my mindset, my choices and the people I choose to surround myself with when my time comes to give birth can impact how my birth plays out. I am not denying the potential for an outcome I would love to avoid, or the potential need for medical interventions. But I know what I need to do and what I need to avoid to put myself in the best possible position for an outcome that will make me proud to be a woman and confident in my capability to be a awesome mom. I will not let the nurses who believe in the “The curse of the nurse” destroy my dream of an empowering birth. We have the power to create magic with our words, I choose to surround myself with people who want to bless me not ones who wish to put a curse on me.
4) As a nurse with dreams of becoming a midwife. When one has been called to something in life, you can only ignore that calling for so long. I too feel that pull to empower women and touch their lives in an even deeper and more meaningful way. As an LD nurse we often meet women for the first time when they walk in the door in active labor, and after they deliver, we may never see them again. We don’t know if they felt empowered or deeply wounded by their birth experience. I dream of working with women throughout pregnancy, birth and postpartum to help guide them to experience birth as the wonderful, life changing right of passage that it can be. The time is not right now. So I will give what I can and continue to pour love into my current role in birth, but not let go of that dream that someday I will be a midwife too.
Thank you NursingBirth for inspiring me to write about my experiences with birth and providing the forum for sharing my love of the work that I do.
Sincerely,
Alethea
http://www.coloradoconsciousbirthing.com