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.


  1. Hello,

    I was hoping to find your email somewhere on your blog so I could write this to you privately instead but I can't seem to find it. I'm sorry if I've missed it- but I feel I have to comment and not click away. However you choose to view your birth and whether or not yours was riskier or more dangerous than others, and whether or not your midwives were instrumental in making it safe, as well as a happy memory for you is, of course, for you to decide. But your statement "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." is false.

    Vasa Previa can be detected and diagnosed before birth and, in doing so, can save the lives of perfectly healthy babies. From the International Vasa Previa Foundation is the following: "When vasa previa is detected prior to labor, the baby has a much greater chance of surviving. Survival rates can range from 50 -95%, but are coming up as vasa previa is being diagnosed more often.

    Vasa previa can be detected during pregnancy with use of transvaginal sonography, preferably in combination with color Doppler. Women with the above risk factors should have this test to rule out vasa previa.

    When vasa previa is diagnosed, elective delivery by cesarean before labor begins can save the baby's life. Ideally, it should be performed early enough to avoid an emergency, but late enough to avoid problems associated with prematurity. The IVPF recommends hospitalization in the 3rd trimester, delivery by 35 weeks, and immediate blood transfusion of the infant in the event of a rupture."

    Again, I'm sorry to have intruded on your blog. I have no idea whether or not the woman at your playgroup's c-section saved her baby's life, whether she had VCI or Vasa Previa, or both. Yes, Vasa Previa IS a very rare condition but it can be diagnosed ahead of time. When it isn't, a tragic outcome is almost always the result. I would direct you to the Personal Stories section on the vasa previa website for further proof.

    My own story is there, too (and has a happy ending):

    I too agree that birth is a natural process that has become over-medicalized. But I know the other side of it as well. I know that birth can sometimes (not often) go spectacularly wrong, that nature isn't perfect, and that doctors can and do save the lives of babies by performing necessary c-sections (not as often as many would have us believe, though). However, with vasa previa, there is no other alternative.

    All the best,

  2. Tiffany,
    Thanks for *intruding* I welcome the chance to have accurate information.:) I acknowledge that there are very serious risk factors associated with this condition. My point being i delivered safely..perhaps she could've as well..the point being NEITHER of us or our care providers knew we had VCI. She was not delivered early for VCI or vasa previa..after she was delivered they saw the VCI so for me i was making more the point of why tell her how her baby could've died..when it didn't and the doctor was inaccurate to state 'your baby WOULD'VE bled to death and died'...because mine didn't. So perhaps hers wouldn't have either since again vasa previa is *rare*. I am not advocating that everyone should recklessly have vaginal births where it could have bad outcomes. I am advocating for treating birth as normal until proven otherwise. So I am glad they are detecting it and babies are being saved. For my personal experience which had a great outcome,It's painful for me to think that if it had been detected and I'd been with an ob that they would've delivered my perfectly healthy baby by csection at 35 weeks..
    I am curious what the symptoms are that indicate you might have a VCI? You mention it but don't elaborate.
    Thank you for sharing! I welcome the opportunity to learn more about VCI for my own knowledge..

  3. As far as I know, there are no outward symptoms of VCI. There are risk factors for it, and those include previous uterine surgery, IVF, and low-lying placentas. I had a low-lying placenta. Most of the time, as I'm sure you know, low-lying placentas move out of the way of their own accord and are of no concern for a vaginal delivery. However, if it is discovered that one has a low-lying placenta, a simple colour doppler ultrasound will tell you whether or not you have vasa previa.

    VCIs are rare (1 in 100 births) but not as rare as vasa previa (1 in 3000). VCI isn't dangerous in itself but if the VCI is located over the cervical os, it is considered a type of vasa previa and it is very dangerous. Baby cannot be delivered vaginally if those exposed vessels are in the way. They are fragile and can easily rupture, causing immense blood loss (for the baby).

    You are right- most harmless VCIs are discovered after the fact, and those are the ones that weren't located between the baby and the cervix. It sounds like the woman from your playgroup (and you as well) had VCI and _not_ vasa previa. I don't know what the reasoning was for her c-section, but it was certainly melodramatic of her doctor to play the hero in that situation.

    Simple screening (ultrasound) for those who have risk factors for vasa previa will reveal who has it and who hasn't. If the ultrasound shows a VCI over the os or a bilobed placenta with unsupported vessels located over the os, then a vaginal delivery would be tragic. The vessels would rupture and the baby would lose all of his blood within a matter of minutes. This is all preventable provided our care providers are aware that vasa previa can be diagnosed before birth and therefore a planned c-section can happen.

    Again, I don't know for sure, but it sounds like your VCI wasn't a problem for a vaginal delivery due to its location. Had it been in the way, your baby would have suffered major blood loss. That didn't happen so I can only assume your umbilical cord was located in a safer position. There have been cases of babies who have died due to VCI (the vessels are easily compressed), but that is rare too, and I am not bringing it up to scare you.

    (part 2 below)

  4. And had your VCI been discovered ahead of time? Most doctors do not treat it any differently. They would not have scheduled you for a c-section at 35 weeks- so no need to worry about that! They might have wanted to make sure it was not a vasa previa, but once that was ruled out, I believe that your birth would have had the same happy outcome.

    Sorry again for what must seem like a walking advertisement for the vasa previa foundation, but it's a cause that's close to my heart, as you can imagine. Had my doctor followed up on my low-lying placenta with a simple colour doppler ultrasound, I would not have woken up to my daughter's blood pouring out of me. He and many other doctors and care providers are still under the impression that vasa previa cannot be detected ahead of time-- and that is simply not true. It is an entirely preventable tragedy and it upsets megreatly every time I hear of another death due to it going undetected.

    Thanks for replying and I'm glad I didn't intrude too much. I hope my tone hasn't come across as holier than thou because that is not my intent at all. I am a very strong advocate for natural birth and parenting and agree that way too many c-sections are being performed.