Archive for the ‘hospital birth’ Category

Sometimes the best-laid plans don’t pan out.  A recent birth made me truly appreciate the miracle of normal, spontaneous birth as I’ve been so lucky to see it happen many times.   I was really beginning to take it for granted.  This was my first experience with induction on a very unfavorable Bishop’s score, with which my client was facing a 50 percent chance of cesarean section.

While in the throes of induced labor, she took the time to think and learn about every intervention thrown at her, an incredibly overwhelming task, especially after planning during her entire pregnancy for a waterbirth with CPMs.

At the end of nearly four days of labor with the full complement of comfort measures, medication and interventions, baby finally began making her way down and out, but…you can guess what happened next.

It is staggering to realize the sacrifices and superhuman effort that mothers give for their babies before they are even born.   Doesn’t matter how many contractions she felt or didn’t feel, how long she had to push or how baby eventually came out, or even if the baby was with us for only a short while and never took a breath.   We moms, we’re all in it together and I wish the general motherhood collective would realize this and start to build each mom up with support and praise, because some need more than others, but there’s not a mom out there who doesn’t need it at all.

And just for fun, this long-awaited peanut modeling my first knitting project!

When I was pregnant, I was bombarded at every turn with advertisements for cord blood banking.  I did my research and decided it was much too expensive, considering the relatively tiny chance that my child would come down with any disease that the cord blood could successfully treat.  So then I moved on to public cord blood donation.  That sounded like a nice option…donate the cord blood to people who  need it right now.  When I asked my midwives about it, they said that public cord banks don’t do business with their birth center.

I was disappointed that my cord blood was going to go to waste, until my midwife gently said, “Your baby needs every drop of that cord blood.   He deserves it more than anyone.”   He spoke with me a little about delayed cord clamping, and how they prefer to wait to clamp the cord until it has stopped pulsing and is limp and yellow, and by then there would not be enough blood to be “milked” out of the cord to really be worth the effort.   I hadn’t really heard much about this, even though I had been powering through Ina May Gaskin’s books and considered myself a birth aficionado.

So I began my research on this new topic,  and I was immediately buried under stacks upon stacks of virtual literature about umbilical cord/placenta physiology, and the harm that is thought to be caused by clamping and cutting the umbilical cord immediately at the moment of birth, oftentimes before the baby has taken its first breath.  The immediate-cutting practice is based on the since-debunked belief that letting a baby get all its blood causes non-physiological (abnormal) polycythemia and jaundice.

The importance of delayed cord clamping has been driven home for me (no pun intended) at the two homebirths I have attended where the baby was “slow to start.”   At each birth, the cord continued to pulse-once up to 30 minutes after the birth- until the baby had achieved a normal breathing pattern and had pinked up and cried.   The placenta did not detach until the baby was stable and breastfeeding almost an hour later.   It was a fascinating lesson on the interplay between mom and baby, the communication via placenta that is so often disturbed during “active third stage management.”  Never mind that the placenta can hold up to 40 percent of a baby’s blood volume.

Upon review of my own birth photos, I noticed that my baby’s cord was still cut too early, even after 10 minutes had passed.  You can see in this photo that the cord is still purple, coiled and plump.

Contrast this with the cord that had been left for approximately one hour before clamping- limp, thin and white:

(Fortunately, the evidence shows that a delay of at least 30 seconds is sufficient for the baby to get quite a bit of blood volume back.  If my daughter had been struggling to breathe, this would have been a greater issue.)

There are almost no indications for immediate cord clamping (placenta previa/abruption and a torn cord are the only indications.) Meconium, short cord and respiratory distress are NOT indications.

Delayed cord clamping and cord milking is especially important for premature birth.

Babies can be resuscitated on the mother’s chest while the cord is still attached and delivering the baby’s only source of oxygen.  If a flat surface is necessary for chest compressions or intubation, this can be done on a flat board (or cookie sheet, as is done at homebirths) placed next to mother.  And check out this contraption that will hopefully make its way into hospitals!

Dr. Nicholas Fogelson is an OB/GYN that is championing the delayed cord clamping paradigm shift in hospitals.  His blog is the place to start for your own research.

Here is an interesting illustration of what a placenta looks like when it’s still full of the baby’s blood.

Facebook page where you can get yourself buried in the latest research on delayed cord clamping.

When I started working as a doula, I took for granted that I would be working with Karen Carr more often than not, as she is a very busy and popular homebirth midwife in this area.   When I met her with my first client, she heard I was a brand-new doula so she rattled off a list of doula books she recommended, which I promptly ordered and devoured.  I looked forward to being a familiar face to her and her birth assistants, as it always makes for good vibes when all the attendants know and respect each other.    So I was shocked to learn that she is facing trial in Alexandria, VA in June for charges of practicing without a license, child abuse and neglect, and involuntary manslaughter for her role as midwife for a breech baby who got stuck, was resuscitated, yet died a few days later in a hospital.

The facts and non-facts are out there in the ether for you to find and judge for yourself.  One particular source of gossip, a thread on the horrid DCUM forum, has actually shown some thoughtful and challenging dialogue and has really given me quite a bit to think about.  It is a difficult situation no matter how you slice it, and I have a feeling that this will become a groundbreaking case.   Where do a mother’s rights end and an unborn baby’s begin?  Does informed consent count for anything?  Why is there only one doctor in the DC/MD/VA area who is able and willing to attend any breech births?  Would it be different for this devastated mother or any mother forced to have a cesarean birth for breech/twins/previous cesarean if our OB/GYNS were actually trained to do their jobs-that is, to manage high-risk vaginal birth-without always resorting to the heavy, sloppy hand of the cesarean?

If fought successfully, this case could change the face of midwifery in this country.  If fought unsuccessfully, it could change the face of midwifery in this country.  Our system is so broken from trying to prevent every single complication and every death, but to what end?    I believe we are actually causing more maternal and infant deaths by trying to reduce risk to zero, an impossible goal as far as life is concerned.  There are no guarantees to life in any type of birth.

I will be supporting Karen to get her back to the untold number of families who have been left without a midwife and are scrambling to find any care provider.  I will be supporting Karen to ensure that my daughter and I have the choice to give birth at home, or via c-section, with no fear of punishment regardless of outcome, if this is our INFORMED CHOICE.  I will be supporting Karen to enable myself to someday practice as a CPM without fear of imprisonment for doing my job.  I will also be supporting Karen to send the message that vaginal breech birth in hospital with care providers skilled and expertly trained in breech, like Karen and many homebirth midwives, MUST become an available option once again.  Too many women are suffering and having to make difficult choices due only to insurance constraints and the lack of skill of our trusted care providers.

http://www.inservicetowomen.org/

A few weeks ago I had the opportunity to go to an ICEA-sponsored seminar given by the Original Gangster Doula, Penny Simkin.  She is one of the founders of DONA International and is the author of such cornerstone birth books as The Birth Partner, Pregnancy, Childbirth and the Newborn, The Labor Progress Handbook, When Survivors Give Birth, and several others.   The Mother of Modern Labor Companionship, you could say.    She looked and talked exactly as she does in her DVD, Comfort Measures for Childbirth, which I found so helpful in my training that I lend it out to my clients so they can get familiar with the various physical and mental pain relief techniques.

This particular seminar was focused on how best to support moms who have an epidural.  It was a very interesting discussion, and not surprisingly, Penny had lots of incredibly thoughtful and common-sense pieces of advice.   The number-one thing I took away from the day is that a mom with an epidural may have numb nerves, but not numb emotions.  The stress hormone cortisol is not relieved by the epidural and so it continues to rise in mom’s body, unless we as birth partners tend to mom’s emotional needs as strenuously as we would have been working on her physical discomfort.

Another helpful Penny-ism is that with an epidural, it shouldn’t be called the “cascade of interventions,” rather, it’s the “epidural package”- all the other things that come with epidurals, such as continuous fetal monitoring, pressure catheters, bladder catheters, blood pressure meds, IVs, oxygen, etc.- are all there just to keep the epidural safe.

And of course, I had to put aside my shyness and get a picture with her.  I’ve met a lot of famous people in my day (Presidents, world leaders, musicians, etc.) but I’ve never been really moved to get a picture!

Here is the manufacturer’s insert for Pitocin, synthetic oxytocin that is given out like candy in hospitals for inductions, to make labors go faster for whatever reason, and as part of third stage management (delivery of placenta) to prevent maternal hemorrhage.

Pitocin Full Prescribing Information

Some of the gems in the package insert include:

Adverse effects on baby:

Bradycardia
Premature ventricular contractions and other arrhythmias
Permanent CNS or brain damage
Fetal death
Neonatal seizures
Low Apgar scores at five minutes
Neonatal jaundice
Neonatal retinal hemorrhage

Adverse effects on mother:

Anaphylactic reaction
Postpartum hemorrhage
Cardiac arrhythmia
Fatal afibrinogenemia
Nausea
Vomiting
Premature ventricular contractions
Pelvic hematoma
Subarachnoid hemorrhage
Hypertensive episodes
Rupture of the uterus

Pitocin is now used in over half of all births in the United States.  And we sit here, wondering why we have one of the worst maternal/infant mortality rates in the world, when the one common element in most of our births appears to be pitocin augmentation in hospitals.   The CDC is finally speaking out against elective inductions, especially before 39 weeks, but even natural, healthy labors can get the “whiff of pit” in the hospital when you aren’t looking.

Pitocin can be a very useful tool in some births.  So, educate yourself on Pitocin by reading the package insert, and be clear about your knowledge of Pitocin with your care providers, through asking for natural methods of induction to be used before Pitocin, and specifying the ways you wish it to be used, such as limiting it to third stage and intramuscularly, for example.  Also, know your rights: you can ask to have the Pitocin turned down or completely off at any time, especially after your body has maintained a good labor pattern.

A new local hospital has announced their ban on photography and video until 5 minutes after a baby is born.  I was not surprised by this,  because I had heard about it months ago from a potential client who called me at just a few weeks pregnant because she was so excited to have her eighth birth photographed, but she had to back out due to the policy.  This will be the only one of her children to not have that first photo on her chest.

The policy and the hospital’s spokespeople deny that it has anything to do with liability and malpractice; rather, the ban is due to “patient privacy concerns and staff distraction.”    Well, it’s family taking pictures of family, or in my case, a client contracted specifically to take pictures and/or provide labor support, so the privacy thing is moot.  And if the staff is admitting that they are “distracted” by a camera, than that is pretty bad, considering that their homebirth midwife counterparts can do their jobs perfectly in the dark, in the water, lying down, squatting, dodging dogs, cats and kids, etc.   You know what is distracting?   A doctor having to be watchful for a camera every second and barking at people to put cameras away, instead of focusing on her damn job.   If this says anything, it says “Avoid our hospital and our staff at all costs, because we are easily distracted and have things to hide.”

My only hope is that this will help mothers realize what else is being stripped from them when they choose a hospital birth, and they will begin to take a closer look at their birth options.  For those moms who are not choosing hospital birth but MUST have a hospital birth for whatever reason, this is another slap in the face.  Nobody should be punished for birthing in a hospital, and that is what it boils down to.   If it’s this easy for a hospital to ban cameras, then doulas are clearly next on the chopping block, because they are the ultimate delivery room distraction for OBs, no?  And here I thought we were moving forward with achieving a better birth climate.

I feel so strongly about this particular issue because I am a birth photographer, obviously.  But I am a birth photographer because I know the power of photographs of a baby emerging and looking at mom for the first time, still connected, still covered in vernix.   When things were going badly in the first few weeks postpartum, I clung to the pictures that my friend took of my daughter’s birth like a life raft.   They were a reminder that I had successfully done something that I set out to do for myself and my daughter, and that I was not a total failure as a mother.

This was the picture that I found myself staring at for weeks as my baby struggled to latch and gain weight and thrive.  This photo and dozens of others would have been lost to me had I had to wait five minutes before we could take pictures.

Five minutes later.   She already looks completely different.   That’s the thing about newborns…they change from second to second.  When I visit my doula babies, it’s like seeing them for the first time.

When are we going to start pushing back against a culture that is systematically stripping all the human elements from birth?    It is not just hospital birth that is at fault; it is absolutely possible to have a beautiful, natural, human hospital birth (I have the PICTURES to prove it.)   It is this lawsuit-hungry, anti-women-and-children, patriarchal American society that we have allowed to spring up around us.

This set of photos is from my first  “cascade of interventions” birth as a doula that ultimately ended in cesarean birth.  I am not sure how this mom and I found each other, but I’m grateful to have had the experience with her.  She taught me lots of life and birth lessons that I will carry with me forever.

All the young whippersnapper pro photographers, of which I am supposedly one, have a photoblog where they show off the fruits of their most recent labor.  (Quite literally, in my case!)   So here we go.  This was my third birth as a doula, a wonderful natural birth attended by a young whippersnapper midwife, a whippersnapper nurse, an awestruck husband, a Hypnobabies Mp3, and myself.

Seconds after her birth.  We were all shocked at how fast she came!