Monday, May 3, 2010

The Birth that Makes me Go Hmmm...

As a mom of 3 little ones..and even more so now that i am a doula..people tell me their birth stories and I love each one. Even when the list of interventions is longer than my arm and the mis-information the doctors gave makes me want to rip my eyes's still uniquely her story..the day she birthed her baby.

Lately I've been thinking about my second daughter is 2 and a half and I've given little thought to certain aspects of her birth. But as a doula I've been learning more and more and am amazed at how many 'dangerous' and 'life threatening' things happened and never occurred to me at the time. I so deeply trusted birth. Lately I've been humbled a bit when thinking of her birth and had to wonder..was I just *lucky*?

My baby girl presented with a nuchal hand...making pushing very painful..not to mention the fact that she was a healthy 9pounds 4oz's to boot. I had heavy bleeding right after delivery so my desires to bond with my baby in the warm waters of her birth and nurse..were dashed in the reality of needing to assess how much blood I was losing.

The room was filled with family and I was busy bonding with my new little one and snugging with my 19 month old as well. All the while my midwives were quietly busy changing my chux pads, pushing on my fundus, taking my vitals, asking me if I felt *dizzy*...and I took no notice. I was just nursing away...laughing..and eating my Jack in the box. Time was passing and the placenta was not midwives quiet busyness was quickly giving way to quiet concern as I continued to bleed heavily. I was informed I was going to get a shot of Pitocin in my leg. Sure..ok I said. I trusted my midwives and knew there must be a reason and never missed a beat. More chux pads were changed and again not knowing why but I was handed a pill and instructed to swallow it...Methergine. Again..Sure ok..

Everyone was asked to leave the room and at a time when I didn't want to EVER push anything out of my vagina again I was being urged to push as hard as I could. My belly was legs were shaking..I didn't feel like anything was happening. And yet the placenta did come..but not all of it. I was instructed to get on my, jello, knees while they inspected the trailing membranes and strategized about getting them to come out. The rest is a blur..but sooner or later I was back in the in arms.

Next as we examined the placenta it is discovered I had a velamentos insertion ( I believe it was explained to me what it was and I discovered it was a really *rare* condition. One of the midwives was a student so she took pictures of it to share with her class. My bleeding continued and at this point they talked with me about the fact that I was losing a lot of blood..faces were serious. I did NOT want to go to the hospital..I was exhausted and desperate to crawl into my own bed with my new baby. So my daugther was born at 10 minutes before 11pm and we eventually went home around 3:30am once my bleeding was satisfactory.

I continued to take the Methergine the next day to help my uterus to clamp down and as was hoped for, I passed a colossal clot into the toilet the next evening. Let's talk about passing the clot shall we? If you've had a vaginal birth your care provider probably told you to *call* if you pass anything larger than a small orange. Well, I sat down to pee and did not so much feel the clot slip out but *heard* the splash and thought, Uh Oh..that sounded BIG. Not wanting to alarm anyone (my husband and mother in law were in the living room) I went into the kitchen and rummaged around for the appropriate utensil to fish it out. What is the appropriate utensil you might wonder..I wondered the same thing and finally settled on a soup ladle. I returned to the scene of what now looked like a murder..with blood smeared all over the toilet seat..filling the toilet bowl..down my get the picture. B.A.D.

Ok, so ladle goes in...and the large pear/small pineapple size clot comes up. Alarmed at it's size..many things went through my mind at lightning speed..*unborn twin? my uterus? do I have only minutes to live?* you know..that kind of thing. So feeling sure I might die I call my midwife and explain what has happened. To my horror (relief?) she is overjoyed and excited. WHAT??? And instructs me to place the clot in a bag and they will be out to dissect it tomorrow. Only while this call is taking place in my bathroom, my living room has now filled with well wishers wanting to see the baby. The guest list included: My Aunt and Uncle from Canada, the youth pastor and his wife from upstairs, our church pastor and his wife...and also my husband and his mother. awesome. So I place clot in requested bag and not knowing what else to do with it I shove it in the right crisper drawer of my refrigerator.

Now ready for my close up I go out to meet the well wishers and say out of the side of my mouth to my husband, Whatever you do.. DO.NOT.OPEN.THE.CRISPER.DRAWER. Of course he responds immediately with, Why? I say, just DON'T! and he asks, Why again and if you are a wife you know exactly the look I gave him in front of company that implied he would SEVERELY regret asking me again and hate his life later if he did. So he did not press me a third time.

Ok, so the MW's come out for the home visit and with extreme excitement they don blue gloves and a scalpel and cut apart the clot I gave birth too the previous day. Here the cause of my continued bleeding is discovered as retained membranes inside the clot. Those membranes secreted just enough hormone to tell my uterus there was still a baby inside and to keep sending blood. Alas..the bleeding was blood loss including Colossal Clot = 1780cc's. Lay men's terms: 1/3 of my total blood supply. Another fact a post partum hemmoraghe is considered to be 500cc's or

Ok..that's the's the review. First of all I am eternally grateful to my midwives for being so incredibly skilled at what they do and that they managed my hemorrhage amazingly. Obviously..I didn't die and have had another beautiful birth with them. What I appreciated is that though they were *concerned* they did their job without causing unnecessary drama. So that when I remember that birth I just recall having ample time to hold and bond with my baby, visit with family, and just enjoy myself. What if I had been in a hospital? How would it have been different?

And now the placenta...

I was recently at a playgroup of all first time mama's with babies ranging in age from 4 months to 1 year. Inevitably the conversation always turns to birth and so it did this day also. A young mother was encouraged to tell her story of how her and her baby are lucky to be alive. I internally take the Lord's name in vain and wait for my tongue to begin bleeding. I won't get into all the details but the story ends that after her healthy baby is csectioned out it comes to light that she had a velamentous insertion which all the medical staff gathered around to see, b/c as I mentioned before it is extremely rare. So it is at this time that the doctor informs the mother that 'its a good thing we didn't have you do a vaginal birth because your baby would have bled to death and died.'

And so since the day 4 months prior that the doctor had said that, this mother really believed that csection saved her baby's life. Also I guarantee you that as many times as she had told that story NO ONE she told had ever encountered this themselves..until *that* day. When I calmly said...Oh, I had a velamentous insertion with my 2nd daughter. I think I almost heard the internal gears grind to a halt and her face froze looking at me. I shrugged my shoulders like it was no big deal and said, Ya..she was 9#4oz..I had her in the was fine. I responded this way because of how my midwives handled my birth by choosing to focus on the joy of a new baby and the celebration of a mother having had a great birth instead of focusing on what *could* have happened. Anyways, I hadn't given her velamentous insertion detail another thought since that day. The new mom looked me dead in the eye and cautiously asked me, Do
you think I could've had a vaginal birth?

Everything in me wanted to scream from the rooftops, YES! YES! YES! but because I am a birth professional working within a tight knit community I must weigh my answers carefully at all times. Personal agendas and Rants are for Facebook Status updates..not playgroups full of first time mom's. So after a moment I answered saying only this, 'I think doctor's make things seem a lot more scary than they really are at times.' And this seemed to appease her but I could see her begin to question her *life saving* c section.

Ok, so I left that playgroup shortly after that interaction, with an extreme headache and a bleeding tongue (metaphorically) and enraged by what I had heard. All the way to Sonic Burger, where I planned to *treat* myself after hearing about all these csections and cytotec induced births, I raged in my car about, WHY WOULD A DOCTOR SAY THAT? WHY WOULD THEY TELL HER WHILE SHE IS CELEBRATING HER BABY THAT HER BABY COULD'VE DIED? WHY?WHY?WHY? No one told me that Samantha could've died...wait..

could she have died?

So I make a call to an awesome local midwife who is like a textbook or birth wikipedia or something. I barely even said Hi before raging into the phone, Tell me everything you know about velamentous insertion..are there risks? Is it dangerous??..she sighed and says, Ah yes the elusive velamentous insertion and vasa previa. She then explained vasa previa to me. And as rare as velamentous insertion is in the first place the fact of vasa previa is even MORE rare.rare.rare. Like that mom took a bigger risk putting her new baby in the car to drive her home than she would've had risked having a vaginal birth. Also I should note that velamentous insertion is not detected on ultrasound but only discovered after delivery of the placenta. the event of vasa previa you wouldn't know it was a risk factor and it wouldnt matter much where you were (at home or hospital) chances are you wouldn't get to the baby in time to save it..a sad fact.

So I thank my midwives for treating birth as it is normal and for treating me like a woman who was in her high harvest day. Because for two and a half years I've retold Sam's birth as a peaceful, powerful experience..where I also bled...a.LOT. but that is SUCH a side note to the actual labor and birth that brought her to us. But now I guess I can say, My baby and I are lucky to be alive after I had a MASSIVE post partum hemmoraghe losing 1/3 of my blood supply and the baby could've bled to death and died via vasa previa from her undiagnosed velamentous insertion. Thank GOD we were in a hospital and everyone is still alive..oh..wait..:)

But in all seriousness after learning about vasa previa I did feel a little bit ill after thinking I *could've* lost my baby but then the truth of the matter is a thousand other things *could've* happened but DIDN'T happen and my daughter is a happy, healthy 2 year old. And really what would've been the point of within an hour of birthing my baby if my midwife had looked at me and informed me of the rare complication that *could've* killed my baby? How would that have impacted the *memory* of her birth..forever? Instead they skillfully, respectfully,and safely cared for me and honored my memory of birth and that is such a gift. A gift I try to be highly aware of when attending other mom's in their births in how I can protect *their* memory of their own birth.

Saturday, February 6, 2010

To Do No Harm

For the second day in row I have laid down to take a nap while my 3 precious babies sleep. I have been nursing a growing boy every hour at night for the last few nights and have been crashing come afternoon. Only as hard as I try to allow sleep to overtake me it's never before I think about one precious baby boy born a few days ago who might go under the knife next week. He had a beautiful, peaceful birth and is right now trusting of his world and environment...maybe snuggled with his mama nursing and warm, percieving the world through the love, safety, and comfort that is surrounding him. However, if I can't get the good research to his parents quick enough...they might hand that precious baby over to a doctor to have his arms and legs strapped to a board...surrounded by doctors and nurses strangers to this tiny baby..who will then proceed to clamp..pull..stretch..tear apart and cut up his penis...HIS PENIS the most sensitive thing on his whole little body...while his helpless, terrified screams fill the room. I just can't fathom stomach begings to ache, i tear up, and my pulse quickens and find that I just can't sleep. So today in order to relieve a little of the anxiety I am posting about it. Occassionaly when the nauseau and sadness about circumcision overwhelms me, which is often, I hold my son close and am slightly satiated in knowing that I was able to spare this one, MY precious son. But my heart still breaks in two for all the my work as a doula I always ask if they know what they are having and when the answer is a boy, in a very non biased and casual way place a reasearch packet w/ dvd's (from peaceful parenting) on the table and encourage them to read through that first before making a decision. That as a doula it's part of my role to give informational support and with that conclude the visit. Each time I've done this even fathers who were dead set on cutting their sons before the research practically wept in relief that they didn't go forward with cutting their sons after becoming educated about it. One even struggles now with anger towards his own parents for allowing it to happen to him.
Every doula has a line when working with families..where they set a boundary and can not work with a family. You spend time on it in doula training to find out if you have that line and what it might be..for some doulas it's smoking..they won't work with a mom who won't quit smoking. I have had a smoking mama...I was stll able to give her great care and support her through her labor. For other's it's epidurals they won't work with a mamaa who is scheduling an epidural. I've worked with several and have been able to help those mom's avoid other interventions including csection because of their having a doula...I was able to add a lot of value in that way and I am proud to have helped them. But THIS..this one is my line..if I have a family that plnas to cut their son and AFTER reading the research STILL wants to move forward to cut their sweet baby..I will refer that family to another doula. It's my line..hard, fast and inflexible. To help a baby have a peaceful, natural birth only to have his parents hand him over a few days after life to a doctor to have the above described so contradictive to what I do.
I have long felt that circumcision was mutiltaion of a baby...but since birthing my first son my heart is softened in a new way about it. Now I weep...WEEP..for babies that get cut and look at my son and can't imagine doing it. And I know that MOST mom's do not want to do this to their babies but feel it's is 'dads decision' b/c ...well i don't know why. It's still YOUR baby that you grew inside your body and whom YOU pushed out and who you nurture at your breast...who you are hardwired on very primal levels to protect at all cannot come naturally to hand your son over.
Jakob was hospitalized at two months old for a UTI...and b/c his little veins were so small and delicate they had to send us down to Children's hospital to place a PICC line in his arm. (after 12 failed attempts to stab him and many, MANY blown veins later). After a lengthy conversation with the anestheseologist (sp?) where Josh and I asked many questions about the procedure and about the things that were 'necessary' etc. I had to hand my brand new baby to this stranger. I'll never forget it and weep even as I write this, all wrapped up and sweetly sleeping in a blanket I gave over my son and the doctor looked in my eyes and said very compassionately, "Sweet baby, yes?" And I nodded and dropped down into the chair and wept openly as I watched her disapear around a corner with my baby. And this for a procedure that would not harm my son or alter him for life or cause post traumatic stress and a bevy of other horrible side effects. And after I had composed myself enough to walk to the waiting room my husband attempted to make me laugh. He suceeded and then feeling I was ok he stepped outside to make some phone calls. However, I sat 25 feet away from the door the doctor disapeared through with my son..this door opened up to a short corridor with 3 other doors..Jakob was inside one of those rooms. As it turned out many staff used this door to come and go..and while Josh was outside the door swung open and I could hear my son screaming. I began to cry so hard..2 more times the door openend and I heard Jakob cry. I had never experienced as a mother such a visceral and primal reaction to my newborn's crying. I had never had a baby in trauma a girls cried b/c they were hungry or tired but this was different. Now granted he was probably crying b/c they were putting cold iodine on the place where the line would go..or perhaps from the quick sting of the shot with the numbing medicine or b/c they had to strap down one of his arms...but his cries were terrified and I was unable to go to him and comfort him. I remember kicking the ground and yelling out loud, COME ON!! in anger. Earlier in Bellingham during the 7 hour ordeal to try to find a vein and including one spinal tap (AWFUL) I had been able to be with lean over him and nurse him while they poked him over and provide him with myself. But now he was where I could not get to him and it was the most maddening of helplessness a mother could ever experience. Now, all of this was out of my control in the sense that he had an infection that was ravaging his body and left unchecked would cause him to turn septic and die. This was necessary. Circumcision is NOT necessary.
Josh returned to find me a sobbing mess in my chair so he quickly grabbed my arm and made me walk go upstairs and walk. I knew it was necessary and that Jakob would be ok and we waited for our pager to go off. Once they paged us it was still an agonizing amount of time before they brought me my baby. I was pacing in and out of the waiting room like a tiger and making the nurse nervous. I was a mama bear now not to be messed with, I wanted my baby. Micheal Odent talks about the oxytocin release between mother and baby that is remarkable...and when I saw the nurses aid FIANLLY come around the corner with my son wrapped in a heated blanket...every fiber of my being, my heart, my soul, my SKIN cried out for that baby. And the relief that flooded my body was intense as I clutched him tightly to my chest and buried my face in his neck. Upon smelling me my son who had been sleeping began to cry loudly as if needing to tell me all about it. Without hesitation I bared my breast and put him to it right there in the hallway and my tears of release splashed onto his little head as he hungrily nursed. It had been over five hours since he had last been nursed due to having to go under anesthesia...I walked all the many hallways and elevators back to our room with him breastfeeding all the while. A nurse asked me if I wanted a blanket to cover up and I said, NOPE. It was over..finally...the line was placed and then we just waited to hear which antibiotics he would recieve (this would take two more days in the hospital) but the trauma of poking my son and handing him off to strangers was over. Once back in our room and night had fallen I remember holding him and crying and apologizing for all that had happened to him and telling him it was all over. I had such anxiety for having this amazingly peaceful home birth with him with a purpose of protecting him from unnecssary trauma and then two weeks later he had just undergone more trauma and more needle pokes than a whole years worth of vaccinations (which we aren't planning on doing). I just felt so bad about it for him..and felt that for a short time it changed his peaceful disposition...maybe it was discomfort from the line but I am mostly sure it was him working through what he had just far outside his previous frame for relating to the world.

And it is that ordeal that I think about and remember the way him and I both felt and again, cannot imagine handing him to someone to do purposeful harm to him when I had a choice to leave him pefect, whole just as he was at birth. Mind boggling. But I digress...I just know that for every baby born male to people I know (for now that is what I have the time and energy to dedicate having 3 small kiddos of my own) I will fight to educate their parents..I will advocate for those babies right to their WHOLE bodies.

From The Star Thrower by anthropologist and writer, Loren Eiseley (1907-1977)

Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out, "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied, "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they will die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, "It made a difference for that one."