Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Thoughts on Becoming a Midwife…. April 2, 2010

Filed under: Ramblings — NursingBirth @ 9:12 AM
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I have written before about my aspirations of becoming a midwife.  The more and more I care for birthing women as an L&D nurse, the more I meet moms out in the community at birth circles, ICAN meetings, etc., the more I read and see and hear about birth and birth politics, the more midwives I meet, the more and more clear it is to me that becoming a midwife is something that I need to do…someday.

I stumbled upon a blog post entitled “Apprentice Midwife Material?” over at Navelgazing Midwife the other day and it really spoke to me.  Throughout the beginning of the post the author goes into detail about the many sacrifices that midwives make in order to do what they love to do.  While reading them over, none came as a surprise to me.  However, no one can really understand what its like to experience them until they become an apprentice and even then your world is still a bit sheltered.

The author then writes:

“I imagine women’s spirits sagging by this point, those sitting in front of me and those reading this, but there are AMAZING parts of being a midwife, too. But if you don’t want… no, CRAVE… all that I said above, then reconsideration of this career is called for.”

I reflected on this statement for a while and I realized that I DO indeed CRAVE it all….the good, the bad, the ugly, the awesome!  But it is still undecided when exactly my time will come to put myself to the test.  Until then I must continue to form relationships with birthing women through my work as an L&D nurse and through my blog.

Thanks for listening 🙂

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How one mom “Walked, moved around, and changed positions” to a successful hospital VBAC! October 23, 2009

Science and Sensibility’s Healthy Birth Blog Carnival #2Walk, move around, and change positions throughout labor

 

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!

 

 

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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!

 

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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!

 

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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!

 

Boy how I love my job sometimes 🙂

 

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*As always, names and any identifying information have been changed to protect privacy.

 

For more information on VBAC please visit: International Cesarean Awareness Network and Childbirth Connection

 

For more information on how you can move and groove through your labor check out: 

  • The Healthy Birth Practice Paper, written by Teri Shilling, MS, CD(DONA), IBCLC, LCCE, FACCE
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  • The Healthy Birth Your Way handout on movement in labor(PDF), produced by Lamaze International and InJoy Birth & Parenting Videos
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  • Companion tip sheets, “Maintaining Freedom of Movement” (PDF) and “Positions for Labor” (PDF)
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    The Ol’ Bait and Switch, OR Finding Out Your OB Has Been Leading You On October 21, 2009

    Submitted on 2009/10/20 at 3:24pm

    Comment under: Urgent Message from ICAN! Please Spread the Word!!

    Dear Nursing Birth,

     

    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!).

     

    Sincerely,

    Kelly

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    Dear Kelly,

    WOW!  I am so sorry that this is happening to you.  You story deeply saddens, frustrates, and angers me because unfortunately YOU ARE NOT ALONE!  Women all over this country have to fight everyday for their VBACs.  Too many are unsuccessful.

    First off I want you to know that your gut is absolutely right; 40 weeks is NOT too late and the research does NOT support your obstetrician’s claims.

    Second, if that hospital is actually considering revising their entire VBAC “policy” in response to one mother who, as it sounds to me, shook the boat a little bit by demanding better care as well as exercising her right to informed refusal, they are absolutely outrageous and ridiculous!  I would be skeptical of that story if I hadn’t recently read this about the sign placed at the entrance of the Aspen’s Women Center in Provo, Utah.

    Third, sounds to me like you did everything right!  You found what you thought was a VBAC supportive care provider, you researched your options and decided you wanted to stack as many cards in your favor as you could for a successful VBAC by planning a drug-free/intervention-free childbirth, you wrote up a birth planthat you painstakingly went through “line by line” with your physician early on in your pregnancy, you have sought out and taken childbirth preparation classes that are geared towards not only providing knowledge about how to have a successful natural childbirth but also help in preparing mentally and emotionally for such an important journey (and on top of that you took those classes with your husband!), and you even hired a doula.  (Yup!  Just as I suspected…you did everything you could!)  So what happened?!?!…

    Unfortunately you are a victim of the ol’ bait and switch.

    It happens to women everyday around this country.  And its existence is further proof that our maternity system is broken, in shambles really.  There are some obstetricians, family practice physicians, and yes, even midwives that have become really friggin’ good at this awful game.  Women write in to me all the time with similar frustrations and complaints as yours, Kelly.  And I always find myself helpless and speechless.  I don’t know how to help women avoid it and I struggle everyday in my own professional life with how to fight it and stop it!

    The worst part of the ol’ bait and switch is the feeling of betrayal that most women report experiencing after they have been victimized they this outrageous action.  (I want to note that I used the terms “betrayal” and “victimized” on purpose.  I understand that they are very strong words but I feel they are the best to describe this very serious phenomenon).  So why does it happen?  Both from what I have personally experienced as a labor and delivery nurse as well as what I have read (for example: Born in the U.S.A by Marsden Wagner and Pushed by Jennifer Block) there is not one simple answer for why some healthcare providers use this “technique.”  But there is no doubt in my mind that money, greed, fear of litigation, fear of losing patients, competition, superciliousness, willful ignorance, impatience, convenience, blatant disregard for evidenced based medicine, favoritism for the “because we’ve always done it this way” model of practice as well as favoritism for the paternalistic provider-patient model of practice (that is, the care provider only presents information on risks and benefits of a procedure/test etc. that he or she thinks will lead the patient to make the “right” decision (i.e. the provider supported decision) regarding health care) all have something to do with it.  Providers who practice the ol’ bait and switch fall somewhere on the, what I like to call “Asshole to Apathy,” spectrum.   Some may be bigger assholes than others, but in the end, they all fall somewhere on that spectrum in my experience.

    [PHEW!  Okay, WOW!  Now I’m all worked up!  Sorry, sorry!  I don’t know where that rant just came from!  But this kind of thing really burns by britches!]

    So Kelly, you must be thinking, “Where does this leave me?”  The good news is that Kristen, a philosophical doula blogger friend of mine over at BirthingBeautifulIdeas is author of an amazing series she calls “VBAC Scare Tactics” which I think is a resource that you, and other moms in your situation, might find very helpful.  What you are describing sounds to me like VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

    In each post she identifies one particular scare tactic, supplies a list of questions that a mother can ask her care provider in response to this scare tactic, and then provides an analysis and/or summary of the research that either challenges or even debunks the scare tactic and its insinuations.  In the introduction to the series she writes,

     

    “Many women who want to have a vaginal birth after cesarean (or VBAC, pronounced “vee-back”) in this country have faced some sort of opposition from their care providers when they have expressed their desire to VBAC.

     

    Sometimes this opposition is blatant.  Sometimes this opposition becomes obvious only at the end of the third trimester. (Many VBAC-ing moms refer to this tactic as a “bait-and-switch” since it involves a supposedly VBAC-supportive care provider rescinding this support once the actual VBAC is imminent.)  Sometimes even a care provider’s “support” of VBAC is instead a conditional, half-hearted, or perhaps sneakily-disguised opposition to VBAC.  These “scare tactics” are often misleading, exaggerated efforts by OBs (and yes, even midwives) to discourage women from VBAC and to encourage them to “choose” a repeat cesarean.  (Of course, it’s not really a choice if your provider won’t even “let” you VBAC, is it?)

     

    If you do find yourself facing such scare tactics, and if you do want to have a VBAC, there are some questions that your care provider should be able to answer when s/he hurls those scary and/or outrageous comments and standards your way.  And if s/he refuses to or even cannot answer these questions, then you might want to consider finding an alternative care provider–one who is making medical decisions based on research, evidence, and even respect for your patient autonomy and not on fear, willful ignorance, or even convenience.”

    Things I love about BirthingBeautifulIdeas’ VBAC scare tactic posts include:

    #1    Her writing is organized and clear.  (You know how much I love organization and lists!)

    #2    She respects research and understands the importance of evidenced based medicine. (In fact, the reason BirthingBeautifulIdeas is aware of much of the research she cites is because she actually used said research studies in weighing her own decision about whether to have an elective repeat cesarean section or instead prepare and plan for a VBAC.)

    #3    She has personal experience with this subject.  (In fact she not only experienced a VBAC scare tactic and the “bait-and-switch” with her former OB, but also made the difficult decision to and successfully did transfer her care to a VBAC supportive care provider late in her pregnancy (at 37 weeks to be exact!) as well as experienced a subsequent and successful VBAC hospital water birth.  Check out her story “My very own VBAC waterbirth”.)

    #4    She does not provide advice.  As she said herself, she is NOT anti-OB nor is she telling women to do anything.  Instead she provides tools that allow women to make their own decisions and stick up for their own decisions about the birth of their babies hoping that in doing so women come out of their birth experiences feeling positive and empowered, regardless of the outcome.

    Kelly, please check out the post VBAC scare tactics (#3): An early eviction dateI was going to write to you about the research and such on the topic but BirthingBeautifulIdeas has already done such a fantastic job herself that it wouldn’t even be worth it to summarize her article.

    While I’m at it, here’s the entire VBAC scare tactics series:

    VBAC scare tactics (#1): VBAC = uterine rupture = dead baby (aka “Why would you want to risk a VBAC only to have a ruptured uterus and a dead baby?”)

    VBAC scare tactics (#2): When bad outcomes in the past affect patient options in the future (aka “I’ve seen a bad VBAC outcome, and it was terrible.  You really don’t want to choose a VBAC over a repeat cesarean.”)

    VBAC scare tactics (#3): An early eviction date (aka “I’ll let you attempt a ‘trial of labor’ just as long as you go into labor before your due date.  After that, we’re scheduling a repeat cesarean.”)

    VBAC scare tactics (#4): No pre-labor dilatation = no VBAC (aka “Since you are 39 weeks pregnant and your cervix isn’t dilated or effaced, it looks like you probably won’t go into labor on your own ‘in time.’   We need to schedule a repeat cesarean and forgo a VBAC attempt.”)

    VBAC scare tactics (#5): VBACs aren’t as safe as we thought they were (aka “You know, VBACs aren’t as safe as we thought they were.  They are much more dangerous to you and your baby.  A repeat cesarean is the safer route.”)

    A VBAC scare tactic interlude (Thoughts and resources on transferring your care to a VBAC supportive care provider, inducing labor when you have a history of a cesarean and weighing the pros and cons of pain medications and interventions if you are planning a VBAC.)

     

    VBAC scare tactics (#6): CPD or FTP = no VBAC (aka“Here in your chart, it says that your cesarean was for failure to progress (FTP).  Oh, and there’s also a note here about cephalopelvic disproportion (CPD).  You’re not really an ideal VBAC candidate since your cesarean wasn’t for fetal distress or breech presentation, so we need to schedule a repeat cesarean.”)

     

    VBAC scare tactics (#7): Playing the epidural card (aka “An epidural can mask the signs of uterine rupture, so I do not permit my VBAC patients to have an epidural during their labors.” OR “In case of an emergency cesarean, I require all of my VBAC patients to have an epidural in place in early labor.  That way, we will not have to wait for the anesthesiologist to get the epidural in place if a uterine rupture occurs.”)

    VBAC Scare Tactics (#8): The MD trump card (aka “Look, I’m the one who has earned the medical degree and I am telling you that you cannot attempt a VBAC.  Your only choice is a repeat cesarean.  Period.”)

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    Kelly you wrote, “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.”  You are right.  You don’t have to do anything they say.  You have the right as a patient to both informed consent as well as informed refusal.  However I want to say a few things.  (Here comes my cyber pep-talk, meant of course to be 100% supportive of whatever you chose and not at all meant to give you advice.  But I don’t think many women get a chance to hear from anyone what I am about to tell you.  To get the full intent of this pep talk just picture me standing behind you vigorously rubbing your shoulders as I squirt water into your mouth from a sports bottle and wipe the sweat off your face.  So here it goes…)

    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.

    I know that it is scary to even think about transferring care to a new care provider so late in the game.  But I encourage you to at least think about it.  Even if you think that there are many limitations in your options regarding availability, insurance, distance, etc. etc, it is worth it to you to at least check it out.  I also encourage you to get in touch with your local ICAN chapter (unless, of course, you have already done that.)  Some of the members might be able to give you some suggestions on VBAC friendly care providers that they know actually attend VBACs!  Sometimes even if a VBAC friendly midwife or doctor is booked they will make an exception for a late transfer of care if a doula friend or former patient calls and asks for a favor.  (I’ve seen it happen before with my local ICAN chapter).  Also ICAN’s website has a variety of helpful articlesfor moms planning a VBAC against hospital or provider resistance.

    I can tell by your story that you are a very strong woman and my gut tells me that you will indeed fight for your rights even if you stay with your current obstetrician.  You just shouldn’t have to do that and it saddens me that any your energy is going to be dedicated to defending yourself during your birth.  Even one tiny little bit of energy devoted to that is too much!  You deserve more!  You deserve better!  I think you said it perfectly when you wrote, “It’s just so frustrating to have to be prepared to battle, and yet relax at the same time!”

     

    I couldn’t agree more!

    So Kelly, I wish you the best of luck!  And like many of my readers, I really wish I was going to be your labor and delivery nurse!  CONGRATULATIONS on your pregnancy and on your upcoming birth!  I will keep you in my thoughts and I hope that you will one day come back and tell us how your birth went!  I hope that this post has helped you in some way.  Oh and please apologize to your friends and family for me since you probably will be wasting a lot more time in front of the computer now that I have provided so much reading material!  Haha!

    Sincerely,

    NursingBirth

     

    Connecticut Docs & Midwives Speak Out For Midwifery! October 16, 2009

    Filed under: In The News — NursingBirth @ 9:40 AM
    Tags: , , ,

    Yesterday the Connecticut newspaper New Haven Register published an opinion piece entitled “Media out of focus on midwifery” by Holly Powell Kennedy, CNM, Charles J. Lockwood, MD, and Edmund Funai, MD and I have to say, I am very very pleased to read such a focused, well-reasoned, supportive article on birth choice, the safety of homebirth, and the need for hospitals around this country to step up and better meet the needs of birthing families!  And for it to be written by two obstetricians and a certified nurse midwife….its just too good to be true!!

     

    Favorite quotes of mine include:

     

    • “Women are not seeking “designer” births. They are looking for humanistic care during pregnancy, labor and birth and are increasingly having difficulty finding that in many hospitals.”

     

    • “It is essential that women are provided with the opportunity to have a supported and safe birth. This means protecting them from preventable harm, and ensuring that clinicians are skilled in appropriate low intervention care and know when it is necessary to intervene.”

     

    • “While midwives and obstetricians will continue to debate the safety and appropriateness of home birth, less controversial is the fact that some women seek to give birth in alternative settings because they do not see hospitals as meeting their needs.”

     

     

    Yes, Yes, and YES!

     

    Thanks to Christina at the Massachusetts Friends of Midwives Blog posting about this article!  What a great start to my day!!

     

    Super Comment! Unexpected Guest Post from a Mother-Friendly L&D Nurse October 14, 2009

    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

     

    One Woman’s Journey To Her Own HBAC Water Birth and 360 Degree Career Change October 12, 2009

    I found this video on It’s Your Birth Right! this morning and was so incredibly moved that I had to share it with you all:

     

    My Journey to a VBAC by Lindsey Meehleis
     

     

    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

     

    Sign the Petition! Demand Accurate Reporting of ALL Birth Options!! October 1, 2009

    Dear Readers,

     

    Choices in Childbirth, a NYC based non-for-profit advocacy group whose mission is to improve maternity care by providing the public, especially childbearing women and their families, with the information necessary to make fully informed decisions relating to how, where, and with whom they will give birth, has recently created a petition in response to NBC’s Today Show segment entitled “The Perils of Midwifery” (later changed to “The Perils of Homebirth” and even later taken off the internet all together!!) speaking out against the segment’s inaccurate, fear mongering, sensationalized, and outrageous portrayal of midwife-attended homebirth, of midwives in general, and of the families who chose this option. 

     

    Below is the letter attached to the petition.  If you feel the same way please consider SIGNING.   On October 9th, the last day of National Midwifery week, representatives from Choices in Childbirth will deliver the letter and petition to The Today Show at NBC’s headquarters in NYC.  The goal is to get at least 5,000 signatures by October 9th and as of today, the petition already has 3,653!!!

     

    Thank you,

     

    NursingBirth

     

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    Petition Letter:

     

    Dear NBC Producers,

        We, the undersigned, collectively voice our deepest concerns over what we believe has been a gross misrepresentation both of midwife-attended homebirth and of the women who choose this option.

     

    While empathizing deeply with the McKenzie family and their loss, we are shocked at the way in which NBC’s “Today Show” chose to portray homebirth as dangerous while choosing to ignore ample medical research that demonstrates its safety in the US and in other developed countries around the world. Not only did the producers of the Today Show ignore journalistic due diligence, they also chose to ignore basic rules of fairness by repeatedly citing doctors and the trade union that represents them while denying midwives and their proponents a voice.   This is simply irresponsible journalism, and misleading to your viewers. We expect more from such a well-respected program.

        We stand in support of families who choose to birth their babies at home with a skilled midwife, not for hedonistic reasons, as the Today Show segment so insultingly suggests, but because they truly believe that it is the best option for themselves and their babies. We support women who choose home birth, who are not following a fad, but who are following their hearts and their informed minds to seek a birth that is both safe and healthy. Far from being a recent trend or fashion, midwifery draws on a continuum of knowledge and experience that goes back many centuries. Midwives are well-trained professionals who specialize in normal birth and provide outcomes that are often superior to obstetrician-attended birth. To suggest otherwise is deeply offensive.
       

    The Today Show missed an opportunity to discuss why, despite its near universal reliance on hospital-based, physician-attended obstetric care in birth, America has one of the worst infant mortality rates in the developed world. It missed an opportunity to discuss the reasons why highly educated, thoughtful and responsible women are choosing a home birth with a qualified midwife as an alternative to a hospital birth- an option that other countries have proven again and again costs less money, necessitates fewer c-sections, and provides better outcomes for mothers and babies than our system. The Today Show missed an opportunity to ask why the United States spent $86 billion in 2006 on maternity care that left the US with one of the worst infant mortality rates in the developed world and left women and their families asking for more choices in their maternity care.
       

    Although every infant death is a terrible tragedy, the real scandal about birth in the US lies not in the death of the McKenzie’s baby alone, but in the fact that 13.6 African American babies die for every thousand live births; an infant mortality rate that is triple that of Denmark or South Korea. What is truly shocking is not that a fraction of women choose home birth, but that our international infant mortality ranking has worsened from 12th in the world in 1960 to 29th in 2004 during the same period that our rates of medical intervention in birth have gone up exponentially- Cesarean section rates alone have more than tripled. 
       

    We are passionate about childbirth issues because we know that, like the rest of the healthcare system in this country, there is much room for improvement.  Drawing battle lines between midwives and doctors and terrorizing the public unnecessarily are hardly constructive means to this end. We call on the Today Show to provide the public with the whole story regarding the evidence and viewpoints supporting the choice of midwife-assisted home birth.

     

    We call on the Today Show to choose responsible journalism.

     

     

    ***SIGN THE PETITION***